Until very recently the treatment of severe tetanus has been an almost hopeless undertaking, the mortality rate ranging upward of 70% for those cases with an incubation period of less than 10 days.1,2 Once the toxin has become "fixed" to the nerve cell there is no known method of removing it or of counteracting its effects. The disease is, however, a self-limited process which leaves no permanent damage in survivors. The cause of death is usually asphyxia, pneumonia, exhaustion, or cardiac failure.
The main problem in the care of these patients is to produce relaxation of the spastic musculature while maintaining adequate pulmonary ventilation. The severe, and usually fatal, case of tetanus is marked by the very narrow margin between the anoxia produced by spasm of the respiratory musculature and the anoxia secondary to attempts to combat this spasm.
Only in the past few years have there been any
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