J. H. Kerr

INVOLVEMENT OF THE SYMPATHETIC NERVOUS SYSTEM IN TETANUS: Studies on 82 Cases

Abstract Retrospective studies are described on a series of 82 patients with tetanus, 44 of whom were treated by tracheostomy, curarisation, and intermittent positive-pressure ventilation. Patients with severe tetanus may develop a characteristic syndrome whose features include sustained but labile hypertension and tachycardia, irregularities of cardiac rhythm, peripheral vascular constriction, profuse sweating, pyrexia, increased carbon-dioxide output, increased urinary catecholamine excretion, and, in some cases, the late development of hypotension. It is argued that this syndrome may be due to continuous but fluctuating overactivity of the sympathetic nervous system.

TREATMENT OF SYMPATHETIC OVERACTIVITY IN TETANUS

Abstract Treatment directed towards suppressing sympathetic overactivity was assessed in four patients who had profound circulatory disturbances during severe tetanus. Chlorpromazine did not provide satisfactory control of these disturbances, and prolonged general anaesthesia, although otherwise successful, was limited by the potential toxicity of the agents used. A combination of propranolol and bethanidine was used in three patients to block adrenergic effector mechanisms, and proved satisfactory in controlling the hypertension, tachycardia, and cardiac dysrhythmias.

Cardiovascular disturbances in severe tetanus due to overactivity of the sympathetic nervous system

I n a previous communication1 based on a retrospective study of 82 cases of tetanus, it was postulated that overactivity of the sympathetic nervous system could account for many features of the disease which cannot be explained on the basis of hyperexcitability of motor neurones. It seems likely that some of these features, in particular the severe cardiovascular disturbances, contribute to the still considerable mortality and morbidity of the disease. This paper describes physiological observations on six patients with severe tetanus treated with curare and intermittent positive pressure ventilation (IPPV). The findings support our previous suggestion that overactivity of the sympathetic nervous system is an integral part of severe tetanus.