ESMOLOL IN A CASE OF SEVERE TETANUS - ADEQUATE HEMODYNAMIC CONTROL ACHIEVED DESPITE MARKEDLY ELEVATED CATECHOLAMINE LEVELS

A patient with severe tetanus, who had a sympathetic crisis while seda ted with 30 mg/h diazepam and 30 mg/h morphine, is described. Satisfac tory control of the haemodynamic crisis was achieved with bolus doses of esmolol to a total of 180 mg. A disturbing finding was that althoug h there was adequate control of the tachycardia and hypertension, arte rial catecholamine levels remained markedly elevated. Adrenaline level s of 531 pg/ml (normal 10 - 110 pg/ml) and noradrenaline levels of 1 0 36 pg/ml (normal 100 - 500 pg/ml) were recorded when the patient had a systolic arterial pressure of 110 mmHg and a heart rate of 97/min. Th e implications of this finding are discussed.