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Chest wall rigidity in two infants after low-dose fentanyl administration

Elisabeth Dewhirst1, Aymen Naguib, Joseph D Tobias

  • 1Department of Anesthesiology, Nationwide Children's Hospital and the Ohio State University, Columbus, OH 43205, USA.

Pediatric Emergency Care
|May 8, 2012
PubMed

Insights

Fentanyl can cause rare chest wall rigidity in infants, even at low doses. This adverse effect necessitates neuromuscular blocking agents and mechanical ventilation for respiratory support.

Area of Science:

  • Anesthesiology
  • Pediatric Pharmacology
  • Critical Care Medicine

Background:

  • Fentanyl, a potent synthetic opioid, is widely used for analgesia and anesthesia.
  • Skeletal muscle rigidity is a known, albeit rare, adverse effect of fentanyl and other synthetic opioids.
  • This rigidity can affect respiratory muscles, leading to ventilation impairment, hypercarbia, and hypoxemia.

Observation:

  • Two infants developed severe chest wall rigidity after receiving analgesic doses of fentanyl.
  • The condition required intervention with neuromuscular blocking agents and mechanical ventilation.
  • This adverse effect occurred despite the administration of low doses of fentanyl, particularly in young patients.

Findings:

  • Chest wall rigidity is a rare but serious adverse effect of fentanyl, especially in neonates and infants.
  • The risk is not limited to high doses; low doses can also precipitate this condition in susceptible pediatric populations.
  • Prompt recognition and management, including neuromuscular blockade and ventilatory support, are crucial.

Implications:

  • Clinicians should maintain a high index of suspicion for fentanyl-induced chest wall rigidity in infants and children.
  • Understanding the pathophysiology is key to managing this rare complication effectively.
  • This highlights the need for careful dosing and monitoring of fentanyl in pediatric patients, particularly neonates.

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