Midazolam for prolonged intravenous sedation in patients with tetanus

Midazolam was used for prolonged sedation in ten adult patients with severe tetanus in the Intensive Care Unit for periods ranging from 10 to 50 days. An infusion was started soon after induction and adjusted according to clinical needs. All the patients were intubated and ventilated and in addition received morphine 1-2 mg/hr and alcuronium or pancuronium infusion. Two patients died from complications of tetanus. Six patients recovered from the effects of midazolam within 24 hrs of the cessation of infusion. Recovery took 48 and 72 hrs respectively in the other two patients. Midazolam is a suitable drug for long-term sedation in patients with tetanus. However, dose requirements are variable and recovery may be delayed in some patients

Plasma cholinesterase in pregnancy: effect of enzyme activity on the duration of action of succinylcholine

The duration of action of succinylcholine, 1 mg/kg and plasma cholinesterase activity were compared in 25 pregnant women undergoing cesarean section and 25 non-pregnant women undergoing elective surgery. Neuromuscular activity was assessed by observation of thumb adduction, following stimulation of the ulnar nerve at the wrist. The duration of action of succinylcholine was significantly longer and enzyme levels significantly lower in the pregnant women. Monitoring of neuromuscular function is recommended when succinylcholine is used in pregnant women