Fentanyl-Induced Chest Wall Rigidity in the Intensive Care Unit

Objective: To report a case of chest wall rigidity induced by low dose fentanyl infusion given for post-operative analgesia. Data Sources: The data was gathered from medical record. Study Selection: A 71-year-old woman developed severe postoperative ventilator dyssynchrony characterized by persistent hypercarbia, decreased pulmonary compliance, and episodic breath holding. Deepened levels of sedation with midazolam and fentanyl infusion at escalating doses were required to provide adequate ventilation; efforts at weaning the patient off sedation were met with worsened ventilator dyssynchrony. Ventilation improved only with neuromuscular relaxation and the cessation of fentanyl. Data Extraction: The data were extracted from the medical record. Data Synthesis: The data were synthesized from the patient’s medical record. Conclusions: Fentanyl is used frequently because of its modest side effect profile; however, our experience illustrates the need for continued appreciation of chest wall rigidity, a severe potential side effect.