Chest wall rigidity in two infants after low-dose fentanyl administration

Pediatr Emerg Care. 2012 May;28(5):465-8. doi: 10.1097/PEC.0b013e3182535a2a.


Since its introduction into clinical practice, it has been known that fentanyl and other synthetic opioids may cause skeletal muscle rigidity. Involvement of the respiratory musculature, laryngeal structures, or the chest wall may impair ventilation, resulting in hypercarbia and hypoxemia. Although most common with the rapid administration of large doses, this rare adverse effect may occur with small doses especially in neonates and infants. We present 2 infants who developed chest wall rigidity, requiring the administration of neuromuscular blocking agents and controlled ventilation after analgesic doses of fentanyl. Previous reports regarding chest wall rigidity after the administration of low-dose fentanyl in infants and children are reviewed, the pathogenesis of the disorder is discussed, and treatment options offered.

Publication types

  • Case Reports

MeSH terms

  • Analgesics, Opioid / administration & dosage
  • Analgesics, Opioid / adverse effects*
  • Dose-Response Relationship, Drug
  • Female
  • Fentanyl / administration & dosage
  • Fentanyl / adverse effects*
  • Follow-Up Studies
  • Humans
  • Hypercapnia / drug therapy
  • Hypercapnia / etiology
  • Infant
  • Infant, Newborn
  • Injections, Intravenous
  • Muscle Rigidity / chemically induced*
  • Muscle Rigidity / complications
  • Muscle Rigidity / drug therapy
  • Naloxone / therapeutic use
  • Narcotic Antagonists / therapeutic use
  • Thoracic Wall*


  • Analgesics, Opioid
  • Narcotic Antagonists
  • Naloxone
  • Fentanyl