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. 1990 Jan-Feb;37(1):46–48.

Ineffective Ventilation During Conscious Sedation Due to Chest Wall Rigidity After Intravenous Midazolam and Fentanyl

William E Ackerman, James C Phero, Gregg T Theodore
PMCID: PMC2163527  PMID: 2077987

Abstract

Chest wall rigidity has been reported after the administration of high-dose intravenous fentanyl. This case report supports the observation that low-dose intravenous fentanyl may also cause chest wall rigidity. The treatment of chest wall rigidity with naloxone or neuromuscular blocking agents is controversial. A discussion of the management of fentanyl-induced chest wall rigidity is presented.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Askgaard B., Nilsson T., Ibler M., Jansen E., Hansen J. B. Muscle tone under fentanyl-nitrous oxide anaesthesia measured with a transducer apparatus in cholecystecomy incisions. Acta Anaesthesiol Scand. 1977;21(1):1–4. doi: 10.1111/j.1399-6576.1977.tb01185.x. [DOI] [PubMed] [Google Scholar]
  2. Blasco T. A., Lee D., Amalric M., Swerdlow N. R., Smith N. T., Koob G. F. The role of the nucleus raphe pontis and the caudate nucleus in alfentanil rigidity in the rat. Brain Res. 1986 Oct 29;386(1-2):280–286. doi: 10.1016/0006-8993(86)90164-2. [DOI] [PubMed] [Google Scholar]
  3. Bonnet F., Kergrohen F., Lafosse J. E., Loriferne J. F., Salvat A., Debras C. Post-operative rigidity after fentanyl administration. Eur J Anaesthesiol. 1986 Sep;3(5):413–416. [PubMed] [Google Scholar]
  4. Christian C. M., 2nd, Waller J. L., Moldenhauer C. C. Postoperative rigidity following fentanyl anesthesia. Anesthesiology. 1983 Mar;58(3):275–277. doi: 10.1097/00000542-198303000-00015. [DOI] [PubMed] [Google Scholar]
  5. Desaiah D., Ho I. K. Effects of acute and continuous morphine administration on catecholamine-sensitive adenosine triphosphatase in mouse brain. J Pharmacol Exp Ther. 1979 Jan;208(1):80–85. [PubMed] [Google Scholar]
  6. Desmonts J. M., Bohm G., Couderc E. Hemodynamic responses to low doses of naloxone after narcotic-nitrous oxide anesthesia. Anesthesiology. 1978 Jul;49(1):12–16. doi: 10.1097/00000542-197807000-00005. [DOI] [PubMed] [Google Scholar]
  7. Ellenbroek B., Schwarz M., Sontag K. H., Jaspers R., Cools A. Muscular rigidity and delineation of a dopamine-specific neostriatal subregion: tonic EMG activity in rats. Brain Res. 1985 Oct 14;345(1):132–140. doi: 10.1016/0006-8993(85)90843-1. [DOI] [PubMed] [Google Scholar]
  8. Hill A. B., Nahrwold M. L., de Rosayro A. M., Knight P. R., Jones R. M., Bolles R. E. Prevention of rigidity during fentanyl--oxygen induction of anesthesia. Anesthesiology. 1981 Oct;55(4):452–454. doi: 10.1097/00000542-198110000-00021. [DOI] [PubMed] [Google Scholar]
  9. Iwamoto E. T., Ho I. K., Way E. L. Elevation of brain dopamine during naloxone-precipitated withdrawal in morphine-dependent mice and rats. J Pharmacol Exp Ther. 1973 Dec;187(3):588–567. [PubMed] [Google Scholar]
  10. Jaffe T. B., Ramsey F. M. Attenuation of fentanyl-induced truncal rigidity. Anesthesiology. 1983 Jun;58(6):562–564. doi: 10.1097/00000542-198306000-00015. [DOI] [PubMed] [Google Scholar]
  11. Klausner J. M., Caspi J., Lelcuk S., Khazam A., Marin G., Hechtman H. B., Rozin R. R. Delayed muscular rigidity and respiratory depression following fentanyl anesthesia. Arch Surg. 1988 Jan;123(1):66–67. doi: 10.1001/archsurg.1988.01400250076013. [DOI] [PubMed] [Google Scholar]
  12. Leiter J. C., Knuth S. L., Krol R. C., Bartlett D., Jr The effect of diazepam on genioglossal muscle activity in normal human subjects. Am Rev Respir Dis. 1985 Aug;132(2):216–219. doi: 10.1164/arrd.1985.132.2.216. [DOI] [PubMed] [Google Scholar]
  13. Moore D. C., Bush W. H., Burnett L. L. Celiac plexus block: a roentgenographic, anatomic study of technique and spread of solution in patients and corpses. Anesth Analg. 1981 Jun;60(6):369–379. [PubMed] [Google Scholar]
  14. Scamman F. L. Fentanyl-O2-N2O rigidity and pulmonary compliance. Anesth Analg. 1983 Mar;62(3):332–334. [PubMed] [Google Scholar]
  15. Sokoll M. D., Hoyt J. L., Gergis S. D. Studies in muscle rigidity, nitrous oxide, and narcotic analgesic agents. Anesth Analg. 1972 Jan-Feb;51(1):16–20. [PubMed] [Google Scholar]
  16. Vaughn R. L., Bennett C. R. Fentanyl chest wall rigidity syndrome--a case report. Anesth Prog. 1981 Mar-Apr;28(2):50–51. [PMC free article] [PubMed] [Google Scholar]
  17. Weinstein S. H., Pfeffer M., Schor J. M. Metabolism and pharmacokinetics of naloxone. Adv Biochem Psychopharmacol. 1973;8(0):525–535. [PubMed] [Google Scholar]

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