Korean J Crit Care Med.  2016 May;31(2):118-122. 10.4266/kjccm.2016.31.2.118.

Recurrent Desaturation Events due to Opioid-Induced Chest Wall Rigidity after Low Dose Fentanyl Administration

• Ham SY
• Lee BR
• Ha T
• Kim J
• Na S

• KMID: 2350918
• DOI: http://doi.org/10.4266/kjccm.2016.31.2.118

Abstract

Opioid-induced chest wall rigidity is an uncommon complication of opioids. Because of this, it is often difficult to make a differential diagnosis in a mechanically ventilated patient who experiences increased airway pressure and difficulty with ventilation. A 76-year-old female patient was admitted to the intensive care unit (ICU) after surgery for periprosthetic fracture of the femur neck. On completion of the surgery, airway pressure was increased, and oxygen saturation fell below 95% after a bolus dose of fentanyl. After ICU admission, the same event recurred. Manual ventilation was immediately started, and a muscle relaxant relieved the symptoms. There was no sign or symptom suggesting airway obstruction or asthma on physical examination. Early recognition and treatment should be made in a mechanically ventilated patient experiencing increased airway pressure in order to prevent further deterioration.

Keyword

analgesics, opioids; asthma; muscle rigidity; lung diseases, obstructive

MeSH Terms

Aged
Airway Obstruction
Analgesics, Opioid
Asthma
Diagnosis, Differential
Female
Femur Neck
Fentanyl*
Humans
Intensive Care Units
Lung Diseases, Obstructive
Muscle Rigidity
Oxygen
Periprosthetic Fractures
Physical Examination
Thoracic Wall*
Thorax*
Ventilation
Analgesics, Opioid
Fentanyl
Oxygen

Figure

• 

  Fig. 1. Perioperative chest radiograph. (A) Preoperative chest radiograph showed focal bronchiectasis at left lower lung field and there was no definite abnormal lung consolidation or collapse. (B) Postoperative chest radiograph showed left pleural effusion (C) Three hours after ICU arrival, the amount of pleural effusion was decreased. (D) On POD#2, there was no definite abnormal lung consolidation or collapse. ICU: intensive care uint.

Reference

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