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Treating severe tetanus with muscle paralysis and intermittent positive pressure ventilation


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European Journal of Anaesthesiology: May 1998 - Volume 15 - Issue 3 - p 380


Doctors Attygalle and Karalliede [1] state that I introduced the concept of treating severe tetanus with muscle paralysis and intermittent positive pressure ventilation. I am afraid that this is not true. In the English literature survivals after treatment by muscle paralysis with d-tubocurarine and intermittent positive pressure ventilation were recorded in 1954 by Lassen and colleagues in Copenhagen [2] and by Honey et al. in Oxford [3], whilst Forrester [4] described a successful case in which paralysis was produced by suxamethonium.

Claude Bernard's experiments which demonstrated that curare acted at the neuromuscular junction were first published in 1850 [5] and the first description of the clinical use of curare in human tetanus was published in the USA in 1858 [6]. Spencer Wells described its use in three cases of tetanus in 1859 [7] and there were also case reports from France [8]. In 1934, Florey et al.[9] described how they had attempted to treat experimental tetanus in rabbits with curare and ventilation by a tank ventilator; these experiments probably stimulated further trials of curare in humans by Cole [10] and West [11]. In the late 1940s and early 50s there were several case reports describing the use of curare with a tank ventilator but the difficulties of nursing and airway care militated against the widespread use of this technique. When these difficulties were overcome by the technique advocated by lbsen and Lassen, muscle relaxant drugs could be used in therapeutic doses without fear of respiratory complications. However, as the authors point out, these are not the only complications which occur during the, necessarily long, period of treatment.


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2 Lassen HCA, Bjorneboe M, Ibsen B, Neukirch F. Treatment of tetanus with curarisation, general anaesthesia, and intratracheal positive pressure ventilation. Lancet 1954; 2: 1040-1044.
3 Honey GE, Dwyer BE, Crampton Smith A, Spalding JMK. Tetanus treated with tubocurarine and intermittent positive pressure respiration. Lancet 1954; 2: 442-443.
4 Forrester ATT. Treatment of tetanus with succinylcholine. BMJ 1954; ii: 342-344.
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6 Sayre LA, Burrall FA. Two cases of traumatic tetanus. N Y J Med 1858; 4: 250-253.
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8 Wells TS. Three cases of tetanus in which "woorara" was used. Proc R Med Chir Soc (Lond) 1859; 3: 142-157.
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10 Cole LB. Tetanus treated with curare. Lancet 1934; 2: 475-477.
11 West R. Intravenous curarine in the treatment of tetanus. Lancet 1936; 1: 12-16.
© 1998 European Society of Anaesthesiology