Opioid-induced rigidity after intravenous fentanyl.
BACKGROUND
Large doses of intravenous opioids may cause severe rigidity and prevent spontaneous or controlled ventilation. The mechanism of this effect appears to be neuraxis dopamine antagonism. Rigidity after analgesic doses of fentanyl has not been reported previously.


METHODS
A pregnant woman receiving haloperidol for multiple psychiatric conditions presented for evaluation of vaginal bleeding. Intravenous fentanyl was administered to facilitate vaginal examination. Severe rigidity of the extremities and truncal region occurred, which prevented spontaneous or assisted ventilation.


CONCLUSIONS
Opioid administration may result in rigidity and respiratory embarrassment. Decreased analgesic requirements in pregnancy and concomitant butyrophenone administration may predispose to opioid-induced rigidity.
Viscomi
C M
CM
Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, USA.
Bailey
P L
PL
D000328:Adult; D018686:Anesthetics, Intravenous / Q000009:adverse effects*; D014150:Antipsychotic Agents / Q000009:adverse effects; D004357:Drug Synergism; D005260:Female; D005283:Fentanyl / Q000009:adverse effects*; D005836:Genitalia, Female / Q000293:injuries*; D006220:Haloperidol / Q000009:adverse effects; D006801:Humans; D009127:Muscle Rigidity / Q000139:chemically induced*; D010808:Physical Examination; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis*; D012652:Self Mutilation / Q000150:complications / Q000175:diagnosis*; D014592:Uterine Hemorrhage / Q000209:etiology
D018686:Anesthetics, Intravenous; D014150:Antipsychotic Agents; D006220:Haloperidol; D005283:Fentanyl