Use of esmolol to control autonomic instability of tetanus

Tetanus is often accompained by autonomic instability, rendering hemodynamic management difficult. Death is frequently secondary to an inability to control this instability. A variety of modalities have been used to stabilize the cardiovascular system, but all are not ideal. Esmolol offers theoretical advantages over other modalities. We report a case of severe tetanus in which a continuous infusion of esmolol was effective in controlling the autonomic instability.