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Morphine Therapy Controls Autonomic Hyperactivity in Tetanus

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Supported by Grant GM-15904-09 from the National Institute of General Medical Sciences.

Respiratory Intensive Care Unit and Laboratories of the Department of Anesthesia, Harvard Medical School at the Massachusetts General Hospital; Boston, Massachusetts

Ann Intern Med. 1978;88(5):653-654. doi:10.7326/0003-4819-88-5-653
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Cardiovascular dysfunction is a well-recognized complication of generalized tetanus in man (1, 2). Both alpha and beta adrenergic blocking agents have been advocated to control arrhythmias and decrease the extreme fluctuations in systemic blood pressure (3). Prys-Roberts and associates (3) reported successful control of sympathetic overactivity with inhalation anesthetics but stressed that toxic effects limited their usefulness. The following case of severe generalized tetanus in the adult associated with autonomic hyperactivity shows successful management with large doses of intravenous morphine.

A 43-year-old previously healthy male construction worker developed trismus, generalized seizures, and upper airway obstruction 8 days after lacerating his


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