Successful management of severe generalized tetanus in a 23-year man with Phenobarbital adjuvant: a case reportArezoo Ahmadi1, Elahe Karimpour-Razkenari2, Ramin Ansari2, Mahforouzalsadat Marashi3, Hamidreza Sharifnia1, Atabak Najafi1, Mojtaba Mojtahedzadeh2*1 Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran2 Department of Anesthesiology and Critical Care, School of Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.3 Department of Infectious Disease and Tropical Medicine, School of Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.Corresponding author: Mojtaba Mojtahedzadeh; Pharmacist; Board Certified of Pharmacotherapy Specialty; Fellowship of Critical Care Pharmacotherapy; Department of Clinical Pharmacy, Tehran University of Medical Sciencesmojtahed@tums.ac.irSina Hospital, Imam Khomeini St, Hasanabad Square, Tehran, IranTel: +982164120Postal code: 1136746911Fax number: 00982166348587Abstract With a mortality rate of up to 50%, generalized tetanus is still a global concern, especially in low and middle-income countries. A 23-year-old man from Afghanistan was admitted to Sina Hospital, affiliated with Tehran University of Medical Sciences, with the chief complaint of generalized severe spasms and lockjaw. The patient had a history of skin lesions and had never been vaccinated against tetanus. He admitted to the intensive care unit after intubation in emergency room, with diagnose of severe generalized tetanus. After receiving tetanus immunoglobulin and intravenous metronidazole, a combination therapy of midazolam, propofol, atracurium and morphine was administered. Due to the refractory muscular spasms intravenous phenobarbital started and little by little recovery was achieved. With no symptom recurrence, after receiving the first 2 doses of the Td vaccine, the patient was discharged on day 42.Keywords: Tetanus, phenobarbital, Intensive care
