Tuesday August 7, 2007
Fentanyl induced chest wall (thoracic) rigidity - FITR

Fentanyl is one of the most commonly used analgesic in ICUs. One of the relatively unknow but common side effect of Fentanyl is chest wall rigidity which was first reported about 25 years ago and may happen with low dose. Chest wall rigidity itself can lead to respiratory distress causing hypercapnia, and hypoxemia leading to bradycardia. Moreover, it may also make intubation difficult as often chest wall rigidity is associated with laryngospasm. Treatment is reversal with Naloxone. If respiratory failure does not resolve, airway should be secured followed with sedation and neuromuscular blockade till fentanyl wears off. The mechanism of action is not known but suspected to be neuraxis dopamine antagonism.


Fentanyl induced thoracic rigidity is relatively more common in neonates.




References: click to get abstract/article

1. Rigidity and hypercarbia associated with high dose fentanyl induction of anesthesia (Letter). Anesth Analg 1981; 60: 362–3

2. Opioid-induced rigidity after intravenous fentanyl - Obstetrics & Gynecology 1997;89:822-824