Fentanyl-induced chest wall rigidity

• Published in: Chest Vol. 143; no. 4; p. 1145
• Main Authors: Çoruh, Başak, Tonelli, Mark R, Park, David R
• Format: Journal Article
• Language: English
• Published: United States 01.04.2013
• Subjects: Aged; Analgesics, Opioid - adverse effects; Analgesics, Opioid - pharmacology; Bronchoscopy - adverse effects; Bronchoscopy - methods; Fentanyl - adverse effects; Fentanyl - pharmacology; Humans; Male; Muscle Rigidity - chemically induced; Muscle Rigidity - drug therapy; Muscle Rigidity - physiopathology; Naloxone - therapeutic use; Narcotic Antagonists - therapeutic use; Thoracic Wall - drug effects; Thoracic Wall - physiopathology; Treatment Outcome
• ISSN: 1931-3543
• DOI: 10.1378/chest.12-2131

Fentanyl and other opiates used in procedural sedation and analgesia are associated with several well-known complications. We report the case of a man who developed the uncommon complication of chest wall rigidity and ineffective spontaneous ventilation following the administration of fentanyl during an elective bronchoscopy. His ventilation was assisted and the condition was reversed with naloxone. Although this complication is better described in pediatric patients and with anesthetic doses, chest wall rigidity can occur with analgesic doses of fentanyl and related compounds. Management includes ventilatory support and reversal with either naloxone or a short-acting neuromuscular blocking agent. This reaction does not appear to be a contraindication to future use of fentanyl or related compounds. Chest wall rigidity causing respiratory compromise should be readily recognized and treated by bronchoscopists.