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Fentanyl-induced chest wall rigidity in a neonate: a case report
S Wells1, M Williamson, D Hooker
1North Carolina Baptist Hospitals, Inc., Winston-Salem.
Heart & Lung : the Journal of Critical Care
|May 1, 1994
Summary
Fentanyl can cause chest wall rigidity in infants, even at moderate doses. Prompt reversal of this fentanyl side effect is crucial to prevent brain damage from lack of oxygen.
Area of Science:
- Anesthesiology
- Pediatric Cardiology
- Neonatal Intensive Care
Background:
- Continuous fentanyl infusions are used for pain management in neonates post-cardiac surgery.
- Coarctation of the aorta repair is a complex procedure requiring careful postoperative monitoring.
- Neonates are particularly vulnerable to respiratory complications during anesthesia recovery.
Observation:
- An 8-week-old infant developed chest wall rigidity during recovery from aortic coarctation repair.
- The rigidity onset was temporally associated with a continuous fentanyl infusion.
- The infant received a moderate dose of fentanyl over 30 minutes prior to rigidity.
Findings:
- Fentanyl administration, even at moderate doses, poses a risk for inducing chest wall rigidity in neonates.
- Chest wall rigidity can compromise ventilation and lead to hypoxia.
- Narcotic reversal is an effective intervention to manage fentanyl-induced chest wall rigidity.
Implications:
- Clinicians should be vigilant for chest wall rigidity in neonates receiving fentanyl infusions.
- Early recognition and intervention, including narcotic reversal, are vital to prevent hypoxic injury.
- This case highlights the need for careful dose titration and monitoring of fentanyl in pediatric surgical patients.