Prolonged administration of intrathecal baclofen in a patient with generalized grade 4 tetanus

Michael Aiello; Sounak Roy; Lyndsey Chitty; Brittany Johnson; Matthew Warrick

doi:10.1136/rapm-2024-105491

Prolonged administration of intrathecal baclofen in a patient with generalized grade 4 tetanus

Reg Anesth Pain Med. 2024 May 9:rapm-2024-105491. doi: 10.1136/rapm-2024-105491. Online ahead of print.

Authors

Michael Aiello¹, Sounak Roy², Lyndsey Chitty³, Brittany Johnson⁴, Matthew Warrick¹

Affiliations

¹ Anesthesiology, University of Florida College of Medicine, Jacksonville, Florida, USA.
² Anesthesiology, University of Florida College of Medicine, Jacksonville, Florida, USA sounakroy96@gmail.com.
³ Anesthesiology, UF Health Jacksonville, Jacksonville, Florida, USA.
⁴ Pharmacy, University of Florida Health, Jacksonville, Florida, USA.

PMID: 38724273
DOI: 10.1136/rapm-2024-105491

Abstract

Introduction: This case report presents the management of a 62-year-old woman with generalized grade 4 tetanus, focusing on the innovative use of intrathecal baclofen (ITB) therapy. The patient initially presented with a laceration and subsequently developed severe tetanic spasms, necessitating interventions beyond standard tetanus immunoglobulin and antibiotics due to the condition's progressive and life-threatening nature. The preference for ITB over oral baclofen is highlighted, considering ITB's enhanced bioavailability in the central nervous system and its efficacy in reducing spinal cord reflexes, which is critical for managing severe spasticity.On her return to the emergency department with symptoms of tetanus, the patient received ITB following the failure of oral baclofen to control the spasms. ITB administration necessitated a lumbar drain, which was later substituted with a tunneled intrathecal catheter due to the extended requirement for baclofen infusion and the unavailability of suitable infusion pumps. This scenario represented a significant application of a CADD-Solis external pump for continuous ITB infusion.Transitioning the patient from ITB to oral baclofen was a crucial management step to facilitate discharge and recovery, underscoring the importance of a careful approach to prevent withdrawal symptoms and maintain care continuity. Despite initial complications, including an infection signaled by leucocytosis and confirmed through cerebrospinal fluid culture, the patient was effectively treated and discharged.

Conclusion: This report contributes to the sparse literature on prolonged ITB use for generalized grade 4 tetanus treatment, underlining the need for interdisciplinary collaboration for the best patient outcomes. It showcases the potential of ITB in spasticity management, in reducing the need for sedation, and in shortening the duration of mechanical ventilation, advocating for a tailored approach that utilizes a full spectrum of pharmacological and supportive therapies.

Keywords: Critical Care; Neurotoxicity Syndromes; Neurotransmitter Agents; Synaptic Transmission; Treatment Outcome.