Central Journal of ISA

Open Access Open Access  Restricted Access Subscription Access

Postoperative Chest Wall Rigidity and Myoclonus Following Low Dose Intravenous Fentanyl:A Case Report


Affiliations
1 Department of Anaesthesiology and Intensive Care, KPC Medical College and Hospital, Kolkata, West Bengal, India
 

Opioid induced muscle rigidity and myoclonus is a frequently described complication which occurs more commonly with large doses and rapid administration of the drugs and is observed at the time of induction. In the post-operative period this complication is reported in patients undergoing cardiac surgery, where large dosages of fentanyl or analogs are employed. Rigidity and myoclonus in the postoperative period with analgesic doses of opioids is extremely rare. We report a case where a life threatening chest wall rigidity and myoclonus occurred in a patient where fentanyl was used as an intraoperative analgesic in a relatively low dose. Though the mechanism of occurrence of this phenomenon remains unclear but the fact that the rigidity was terminated with naloxone confirms that it was fentanyl induced.

Keywords

Chest Wall Rigidity, Fentanyl, Myoclonus, Naloxone, Post-Operative.
User
Notifications
Font Size

  • Hamilton WK, Cullen SC. Effect of levallorphan tartrate upon opioid induced respiratory depression. Anesthesiology. 1953; 14:550–4. https://doi.org/10.1097/00000542-195311000-00002.

  • Vaughn RL, Bennett CR. Fentanyl chest wall rigidity syndrome-a case report. Anesth Prog. 1981:50–1. PMid:6943947 PMCid:PMC2516388.

  • Coruh B, Tonelli MR, Park DR. Fentanyl induced chest wall rigidity. Chest. 2013; 143(4):1145–6. https://doi.org/10.1378/chest.12-2131 PMid:23546488.

  • Scott JC, Sarnquist FH. Seizure-like movements during a fentanyl infusion with absence of seizure activity in a simultaneous EEG recording. Anesthesiology. 1985; 62:812–4. https://doi.org/10.1097/00000542198506000-00024.

  • Bowdle TA. Myoclonus following sufentanil without EEG seizure activity. Anesthesiology. 1987; 67:593–5. https://doi.org/10.1097/00000542198710000-00030 PMid:2959172.

  • Chang J, Fish KJ. Acute respiratory arrest and rigidity after anesthesia with sufentanil: A case report. Anesthesiology. 1985; 63:710–11. https://doi.org/10.1097/00000542-198512000-00031 PMid:2932985.

  • Christian CM II, Waller JL, Moldenhauer CC. Postoperative rigidity following fentanyl anesthesia. Anesthesiology. 1983; 58:275–7. https:// doi.org/10.1097/00000542-198303000-00015 PMid:6829964.

  • Dimitriou V, Zogogiannis I, Liotiri D, Wambi F, Taw¬feeq N, Koumi A, et al. Impossible mask ventilation after an unusually low dose fentanylinduced muscle rigidity in a patient with essential tremor: a case report and review of the literature. Middle East J Anaesthesiol. 2014; 22:619–22. PMid:25669008.

  • Ackerman WE, Phero JC, Theodore GT. Ineffective ventilation during conscious sedation due to chest wall rigidity after intravenous midazolam and fentanyl. Anesth Prog. 1990; 37:46–8. PMid:2077987 PMCid: PMC2163527.

  • Phua CK, Wee A, LimA, Abisheganaden J, Verma A. Fentanyl-induced chest wall rigidity syndrome in a routine bronchoscopy. Respiratory Medicine Case Reports. 2017; 20: 205–7. https://doi.org/10.1016/j. rmcr.2017.02.012 PMid:28337407 PMCid:PMC5349614.

  • Bowdle TA, Rooke GA. Postoperative myoclonus and rigidity after anesthesia with opioids. Anesth Analg. 1994; 78:783–6. https://doi.org/10.1213/00000539-199404000-00030 PMid:8135401.

  • Klausner JM, CaspiJ, Lelcuk S, et al. Delayed muscular rigidity and respiratory depression following fentanyl anesthesia. Arch Surg. 1988; 123(1):66–7. https://doi.org/10.1001/archsurg.1988.01400250076013 PMid:3337659.

  • Ham SY, Lee BR, Ha T, Kim J, Na S. Recurrent desaturation events due to opioid-Induced chest wall rigidity after low dose fentanyl administration. Korean J Crit Care Med. 2016; 31(2):118–22. https://doi.org/10.4266/kjccm.2016.31.2.118

  • Smith NT, Benthuysen JL, Bickford RG, et al. Seizures during opioid anesthetic induction-are they opioid-induced rigidity? Anesthesiology. 1989; 71:852–62. https://doi.org/10.1097/00000542-198912000-00008 PMid:2531560.

  • Streisand JB, Bailey PL, TeMaire L, et al. Fentanyl-induced rigidity and unconsciousness in human volunteers. Anesthesiology. 1993; 78(4):629–34. https://doi.org/10.1097/00000542-199304000-00003 PMid:8466061.

  • Vankova ME, Weinger MB, Chen DY, Bronson JB, Motis V, Koob GF. Role of central mu, delta-1, and kappa-1 opioid receptors in opioid-induced muscle ri¬gidity in the rat. Anesthesiology. 1996; 85:574–83. https://doi.org/10.1097/00000542-199609000-00017 PMid:8853088.

  • Soares JH, Brosnan RJ, Smith A, Mayhew PD. Rabbit model of chest wall rigidity induced by fentanyl and the effects of apomorphine. Respir Physiol Neurobiol. 2014; 202:50–2. https://doi.org/10.1016/j. resp.2014.07.017 PMid:25093961.

  • Lui PW, Lee TY, Chan SH. Involvement of locus coe¬ruleus and noradrenergic neuro-transmission in fentanyl-induced muscular rigidity in the rat. Neurosci Lett. 1989; 96:114–9. https://doi.org/10.1016/03043940(89)90252-8.


Abstract Views: 217

PDF Views: 72




  • Postoperative Chest Wall Rigidity and Myoclonus Following Low Dose Intravenous Fentanyl:A Case Report

Abstract Views: 217  |  PDF Views: 72

Authors

Anjum Naz
Department of Anaesthesiology and Intensive Care, KPC Medical College and Hospital, Kolkata, West Bengal, India
Bivash Halder
Department of Anaesthesiology and Intensive Care, KPC Medical College and Hospital, Kolkata, West Bengal, India
Prithviraj Chakraverty
Department of Anaesthesiology and Intensive Care, KPC Medical College and Hospital, Kolkata, West Bengal, India
Avishek Naha
Department of Anaesthesiology and Intensive Care, KPC Medical College and Hospital, Kolkata, West Bengal, India
Nivedita Mukherjee
Department of Anaesthesiology and Intensive Care, KPC Medical College and Hospital, Kolkata, West Bengal, India

Abstract


Opioid induced muscle rigidity and myoclonus is a frequently described complication which occurs more commonly with large doses and rapid administration of the drugs and is observed at the time of induction. In the post-operative period this complication is reported in patients undergoing cardiac surgery, where large dosages of fentanyl or analogs are employed. Rigidity and myoclonus in the postoperative period with analgesic doses of opioids is extremely rare. We report a case where a life threatening chest wall rigidity and myoclonus occurred in a patient where fentanyl was used as an intraoperative analgesic in a relatively low dose. Though the mechanism of occurrence of this phenomenon remains unclear but the fact that the rigidity was terminated with naloxone confirms that it was fentanyl induced.

Keywords


Chest Wall Rigidity, Fentanyl, Myoclonus, Naloxone, Post-Operative.

References