A sum of 154 articles was reviewed from the databases searched. There were no randomized controlled trials or meta-analyses; all were only case reports and case series.
Five reports of magnesium sulfate use in the treatment of sympathetic over-activity and spasms in tetanus were reviewed. The primary endpoints of the reports obtained were based mainly on observations of the respective investigators. No grading systems or standardized guidelines were used to quantify the endpoints of interest.
The dose of magnesium sulfate was variable; three studies used a loading dose of 5 grams IV bolus loading dose. Of the 3 studies, 2 studies used a continuous infusion of 2-3 grams/hour of magnesium sulfate.
One study used an infusion of 1-3 grams per hour. The study by Lubbad and Ho used an infusion of 1-2 grams per hour, with the aim of maintaining the serum magnesium level between 3-4 mmol. There is not enough evidence to support the routine use of magnesium sulfate for the management of sympathetic over-activity and muscle spasms in tetanus. However, this review shows that the collected 61 cases reported suggest that magnesium sulfate has the potential of becoming an ideal treatment in the control of spasm without sedation, prevention of life threatening sympathetic over-activity, advantage of minimal adverse reaction and low cost in the management of tetanus.