[Antispasm therapy using combination of midazolam and propofol for severe tetanus]

A 68-year-old healthy woman without any evidence of recent wound, developed nuchal pain, difficulty in swallowing and trisumus in 10 days. Because of respiratory failure due to generalized muscle spasm, she was intubated and required mechanical ventilation. Midazolam was administered as an antispastic therapy followed by human tetanus immune globulin and tetanus toxoid. Propofol was added on 9 days after intubation, since muscle spasm such as opisthotonus or respiratory spasm did not improve under midazolam and intermittent administration of vecuronium. Thereafter, her muscle spasm and hypertensive response were well controlled. The authors suggested that a combined use of midazolam and propofol was an optional antispastic therapy in patients with severe tetanus.