ABSTRACT
We report about two newborns with sudden onset of inability of mechanical ventilation
due to transient chest wall rigidity after fentanyl i.v. bolus of 2 and 4 μg/kg, respectively,
resulting in severe hypoxemia and secondary bradycardia. A third case developed a
rigidity of the tongue after fentanyl bolus, which created some unusual difficulties
in bypassing the tongue for insertion an endotracheal tube. Because of common usage
of this agent for analgesia we direct attention to the possibility of fentanyl-induced
muscle rigidity. We underline the necessity of a slow bolus injection to prevent this
dangerous adverse effect and we recommend the administration of naloxone and/or muscle
relaxants as therapy in conjunction with mechanical ventilation.
KEYWORD
Analgesia - sedation - fentanyl-induced thoracic rigidity - intensive neonatal care
