Opioids and Chest Wall Rigidity During Mechanical Ventilation
Authors: Jeffrey P. Roan, Navin Bajaj, Field A. Davis, Natalie Kandinata
Journal: Annals of Internal Medicine (2018)

Letters1 May 2018Opioids and Chest Wall Rigidity During Mechanical VentilationJeffrey P. Roan, DO, Navin Bajaj, MD, Field A. Davis, DO, and Natalie Kandinata, BSJeffrey P. Roan, DOSoutheastern Regional Medical Center, Lumberton, North Carolina (J.P.R., N.B., F.A.D.), Navin Bajaj, MDSoutheastern Regional Medical Center, Lumberton, North Carolina (J.P.R., N.B., F.A.D.), Field A. Davis, DOSoutheastern Regional Medical Center, Lumberton, North Carolina (J.P.R., N.B., F.A.D.), and Natalie Kandinata, BSCampbell University School of Medicine, Lillington, North Carolina (N.K.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L17-0612 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Most patients receiving mechanical ventilation require analgesia and sedation, which are commonly provided by opioids, propofol, dexmedetomidine, or benzodiazepines.Objective: To remind clinicians of a rare drug effect that can complicate mechanical ventilation.Case Report: A 56-year-old woman with a history of hypertension, neuropathy, and oxygen-dependent chronic obstructive pulmonary disease was hospitalized for an acute exacerbation of chronic hypercapnic respiratory failure. The patient was afebrile, and renal function and creatine kinase and electrolyte levels were normal. Current medications included albuterol sulfate–ipratropium bromide, bupropion, fluticasone–vilanterol, levofloxacin, methylprednisolone, pregabalin, and valsartan.The patient did not respond to noninvasive positive-pressure ventilation and ...References1. Hamilton WK, Cullen SC. Effect of levallorphan tartrate upon opiate induced respiratory depression. Anesthesiology. 1953;14:550-4. [PMID: 13105006] CrossrefMedlineGoogle Scholar2. 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. [PMID: 25669008] MedlineGoogle Scholar3. Yeon Ham S, Ra Lee B, Ha T, Kim J, Na S. Recurrent desaturation events due to opioid-induced chest wall rigidity after low dose fentanyl administration. Korean Journal of Critical Care Medicine. 2016;31:118-22. CrossrefGoogle Scholar4. Çoruh B, Tonelli MR, Park DR. Fentanyl-induced chest wall rigidity. Chest. 2013;143:1145-6. [PMID: 23546488] doi:10.1378/chest.12-2131 CrossrefMedlineGoogle Scholar5. Viscomi CM, Bailey PL. Opioid-induced rigidity after intravenous fentanyl. Obstet Gynecol. 1997;89:822-4. [PMID: 9166335] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Southeastern Regional Medical Center, Lumberton, North Carolina (J.P.R., N.B., F.A.D.)Campbell University School of Medicine, Lillington, North Carolina (N.K.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L17-0612.This article was published at Annals.org on 9 January 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byNeuropharmacology in the Intensive Care UnitFentanyl‐induced muscle rigidity in a dog during weaning from mechanical ventilation after emergency abdominal surgery: A case reportToxidromes for Working DogsPre-procedural Preparation and Sedation for Gastrointestinal Endoscopy in Patients with Advanced Liver DiseaseOpioids in COVID-19: Two Sides of a CoinChallenges in Sedation Management in Critically Ill Patients with COVID-19: a Brief ReviewSedation, Analgesia, and Paralysis in COVID-19 Patients in the Setting of Drug ShortagesSedation in the Pediatric Intensive Care Unit: Challenges, Outcomes, and Future Strategies in the United StatesInteraction of Opioids with Sedative Practices in the ICUWooden Chest Syndrome: A Case Report of Fentanyl-Induced Chest Wall RigidityBupropion/fentanyl 1 May 2018Volume 168, Issue 9Page: 678KeywordsDisclosureDopaminergicsIntubationMedical risk factorsMusclesOpioidsSedationStiffnessThoraxVentilators ePublished: 9 January 2018 Issue Published: 1 May 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...