Title: Low Dose Fentanyl Infusion Used for Sedation during Mechanical Ventilation Leading to Asynchronous Ventilation - A Case Report
Authors: Akhileshwar, Swati Singh, Sanjay Kumar
DOI: https://dx.doi.org/10.18535/jmscr/v6i12.138
Abstract
Fentanyl induced chest wall rigidity is more commonly observed on high bolus dose of intravenous fentanyl. We report here a case of asynchronous ventilation on low dose fentanyl infusion used for sedation in intensive care unit. Ventilation improved only with neuromuscular relaxation and on cessation of fentanyl. We suggest to have high degree of suspicion for this potentially life threatening side effect of fentanyl on use of this drug.
Keywords: Fentanyl; Mechanical ventilation; chest wall rigidity
Key Messages: Low dose intravenous fentanyl infusion is capable of producing chest wall rigidity.
References
- Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41:263-306.
- Coruh B, Tonelli MR, Park DR. Fentanyl-induced chest wall rigidity. Chest. 2013;1431145-1146.
- Hamilton WK, Cullen SC. Effect of levallorphan tartrate upon opiate induced respiratory depression. Anesthesiology. 1953;14: 550-554.
- Comstock MK, Carter JG, Moyers JR, Stevens WC. Rigidity and hypercarbia associated with high dose fentanyl induction of anesthesia. AnesthAnalg. 1981; 60: 362-363.
- Bennett JA, Abrams JT, Van Riper DF, Horrow JC. Difficult or impossible ventilation after sufentanil-induced anest-hesia is caused primarily by vocal cord closure. Anesthesiology. 1997;871070-1074.
- Rosenberg M. Muscle rigidity with fentanyl: a case report. AnesthProg. 1977;24:50-52
- Malik I, Wilks JA, Singh P, Brydges N (2018). Fentanyl-Induced Chest Wall Rigidity in the Intensive Care Unit. J ClinAnesth Pain Med. 2018; 2:1-3.
- Rim SK, Kim JI, Son YB, Lee JH. Muscular rigidity and pulmonary edema following administration of low dose fentanyl: a case report. Korean J Crit Care Med 2012; 27: 197–201.
- Dimitriou V, Zogogiannis I, Liotiri D, Wambi F, Tawfeeq N, Koumi A, et al. Impossible mask ventilation after an unusually low dose fentanyl-induced muscle rigidity in a patient with essential tremor: a case report and review of the literature. Middle East J Anaesthesiol 2014; 22: 619–22.
- Weinger MB, Cline EJ, Smith NT, Blasco TA, Koob GF. Localization of brainstem sites which mediate alfentanil-induced muscle rigidity in the rat. Pharmacol Biochem Behav. 1988;29:573-580.
- Vankova ME, Weinger MB, Chen DY, et al. Role of central mu, delta-1, and kappa-1 opioid receptors in opioid-induced muscle rigidity in the rat. Anesthesiology. 1996;85:574-583.