Perioperative care of a child with tetanus

Abstract

Tetanus is caused by tetanospasmin, a toxin that is produced by the anaerobic bacterium, Clostridium tetani. Despite widespread vaccination, which limits its incidence in many parts of the world, tetanus may still occur owing to lack of immunisation related to religious tenets, cultural beliefs or inaccessibility to medical care. Of major concern during the perioperative care of such patients is control of the muscle spasms and the propensity for autonomic dysfunction, resulting in blood pressure instability. Ongoing muscle spasms may impair upper airway control or respiratory muscle function, thereby resulting in respiratory failure. Autonomic dysfunction may result in profound hypertension followed by hypotension, bradycardia and asystole. The pathophysiology of tetanus, its clinical manifestations, and current treatment options are discussed. The preoperative implications of tetanus and the care of these patients are reviewed.