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Fentanyl-induced chest wall rigidity and laryngospasm in preterm and term infants
H Fahnenstich1, J Steffan, N Kau
1Department of Neonatology, University Childrens Hospital, Basel, Switzerland. hubert.fahnenstich@unibas.ch
Insights
Low doses of fentanyl can cause chest wall rigidity and respiratory distress in neonates. Naloxone effectively reversed these serious adverse events, including laryngospasm, in infants.
Area of Science:
- Neonatal pharmacology
- Pediatric critical care medicine
- Anesthesiology
Background:
- Fentanyl is commonly used for analgesia and sedation in neonates.
- Muscle rigidity is a known adverse effect of opioids, but its occurrence in neonates at low doses requires further investigation.
Purpose of the Study:
- To evaluate the incidence of muscle rigidity following fentanyl administration in premature and term neonates.
- To describe the clinical presentation and management of fentanyl-induced muscle rigidity in this population.
Main Methods:
- Prospective observational case series conducted in a university hospital neonatal intensive care unit.
- Included 89 preterm and term infants (25-40 weeks gestational age) receiving fentanyl for procedures.
- Monitored for chest wall rigidity, respiratory distress, and other adverse events; naloxone used for reversal.
Main Results:
- Chest wall rigidity occurred in 8 neonates (4%) after low-dose fentanyl (3-5 microg/kg).
- All affected infants experienced respiratory distress, hypercapnia, and hypoxemia, leading to bradycardia.
- Two infants developed laryngospasm associated with rigidity, hindering intubation; naloxone rapidly reversed these effects.
Conclusions:
- Even low doses of fentanyl can induce significant thoracic rigidity in neonates.
- Laryngospasm may be a variant of fentanyl-induced muscle rigidity in this age group.
- Prompt administration of naloxone is crucial for managing these adverse events.
Objective:
To assess the occurrence of muscle rigidity after fentanyl administration in premature and term neonates.
Design:
Prospective case series, observational study.
Setting:
A university hospital neonatal intensive care unit.
Patients:
8/89 preterm and term infants (25-40 wks gestational age) who received fentanyl for perioperative analgesia and sedation or intensive care procedures.
Interventions:
Mechanical or bag mask ventilation and antagonization with naloxone.
Measurements And Main Results:
We observed chest wall rigidity in 8 patients after low dosage of fentanyl (3-5 microg/kg body weight). All patients presented with respiratory distress, hypercapnia, and hypoxemia leading to bradycardia. In two patients, laryngospasm was noted and associated with muscle rigidity, thus making intubation impossible. Naloxone (20-40 microg/kg body weight) reversed the laryngospasm and muscle rigidity immediately, allowing restitution within 1 min. In our patient population, we found fentanyl-induced chest wall rigidity in 4% of neonates after fentanyl administration.
Conclusion:
Even low doses of fentanyl can lead to thoracic rigidity in neonates. Additionally, we observed laryngospasm in two patients and speculate that it might be a variant of muscle rigidity.