Magnesium as first line therapy in the management of tetanus: a
prospective study of 40 patients.

Anaesthesia 2002 Aug;57(8):778-817 Attygalle D, Rodrigo N.

A prospective observational study was conducted to examine the efficacy
and safety of magnesium sulphate for con*trol of spasms and autonomic
dysfunc*tion in 40 patients with tetanus. Magnesium was infused
intravenously, aiming to control spasms despite sup*pression of
patellar reflex or respirato*ry insufficiency. Spasms were
con*trolled in 38 of the 40 patients within a serum Mg2+ range of 2-4
mmol.l-1 with only two patients needing addi*tional neuromuscular
blocking drugs. Seventeen of 24 patients ( 60 years) and six of 16
patients (./=60 years) did not require ventilatory support. Thirty-six
patients were conscious and co-operative throughout their manage*ment.
Sympathetic over-activity was controlled without supplementary
sedation. Overall mortality was 12%; all five deaths were in patients
/= 60 years and no deaths were due to auto-nomic dysfunction. We recommend magnesium as possible first line thera*py in the routine management of tetanus.