Effect of Levalloephan Taetrate Upon Opiate Induced Respiratory Depression

Hamilton, William K.; Cullen, Stuart C.

doi:10.1097/00000542-195311000-00002

Cited by 47 publications

(23 citation statements)

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“…101,102 The effect of opioids on muscle function extends to those of the respiratory pump including muscles of the thorax and the diaphragm. Chest wall rigidity following opioid administration was first described in 1953, 103 and while usually associated with rapid injection, multiple agents, and large doses, it has also occurred when opioids were administered in a conservative fashion. 104 Opioid analgesia has also been shown to increase abdominal muscle activity, 105 and this persistent expiratory muscle activity produces a rapid decrease in end-expiratory lung volume and FRC, contributing to a higher degree of atelectasis.…”

Section: Educationmentioning

confidence: 99%

Postoperative Respiratory Muscle Dysfunction

2013

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Postoperative pulmonary complications are responsible for significant increases in hospital cost as well as patient morbidity and mortality; respiratory muscle dysfunction represents a contributing factor. Upper airway dilator muscles functionally resist the upper airway collapsing forces created by the respiratory pump muscles. Standard perioperative medications (anesthetics, sedatives, opioids, and neuromuscular blocking agents), interventions (patient positioning, mechanical ventilation, and surgical trauma), and diseases (lung hyperinflation, obesity, and obstructive sleep apnea) have differential effects on the respiratory muscle subgroups. These effects on the upper airway dilators and respiratory pump muscles impair their coordination and function and can result in respiratory failure. Perioperative management strategies can help decrease the incidence of postoperative respiratory muscle dysfunction. Such strategies include minimally invasive procedures rather than open surgery, early and optimal mobilizing of respiratory muscles while on mechanical ventilation, judicious use of respiratory depressant anesthetics and neuromuscular blocking agents, and noninvasive ventilation when possible.

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Section: Educationmentioning

confidence: 99%

Postoperative Respiratory Muscle Dysfunction

2013

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“…10 This syndrome classically presents in patients suffering from heart failure or ischemic coronary disease undergoing anesthetic induction using high doses of opioids. Cases associated with lower doses of opioid have also been documented in patients with particular risk factors: extremes of age (newborns, elderly) critical illness with neurological or metabolic diseases, and use of medications that modify dopamine levels.…”

Section: Pathophysiology Of Opioid-induced Rigiditymentioning

confidence: 99%

Fentanyl-induced rigidity during emergence from general anesthesia potentiated by venlafexine

Roy

Fortier

2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To present and discuss a case of opioid-induced rigidity with low-dose fentanyl during recovery from anesthesia.C Cl li in ni ic ca al l f fe ea at tu ur re es s: : A 41-yr-old woman underwent laparotomy for total abdominal hysterectomy and bilateral salpingo-oophorectomy under general anesthesia. She received a total of 500 µg of fentanyl by iv intermittent boluses during the three-hour anesthetic. During emergence from anesthesia, while intubated, the patient presented with rigidity. No changes in ventilatory parameters were measured during the episode. The only notable predisposing factor was treatment with venlafexine, an antidepressant that modifies serotonin and norepinephrine levels. She was successfully treated with iv naloxone 20 µg. The rest of the postoperative period was uneventful.

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“…It was first described by Hamilton and Cullen in 1953 [3]. It primarily results in chest wall and abdominal wall rigidity, also known as the ‘wooden chest syndrome [4].…”

Section: Discussionmentioning

confidence: 99%

Fentanyl-induced chest wall rigidity syndrome in a routine bronchoscopy

Phua¹,

Wee²,

Lim³

et al. 2017

Respiratory Medicine Case Reports

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Combination of sedatives such as fentanyl and midazolam during bronchoscopy is recommended by American College of Chest Physician due to its favourable drug profile. It improves patient comfort and tolerance, and is commonly given unless contraindicated. We describe a rare case of fentanyl-induced chest wall rigidity syndrome during a routine bronchoscopy with endobronchial ultrasound guided-transbronchial needle aspiration (EBUS-TBNA) in a 55 year old male presenting with a lung mass and mediastinal lymphadenopathy. This was effectively managed with neuromuscular blockade, intubation and reversal agents including naloxone. This rare complication should be effectively managed by all bronchoscopist as it carries significant mortality and morbidity if not recognised early. We review the literature on the occurrence of fentanyl-induced chest wall rigidity and its predisposing risks factors.

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Effect of Levalloephan Taetrate Upon Opiate Induced Respiratory Depression

Cited by 47 publications

References 0 publications

Postoperative Respiratory Muscle Dysfunction

Postoperative Respiratory Muscle Dysfunction

Fentanyl-induced rigidity during emergence from general anesthesia potentiated by venlafexine

Fentanyl-induced chest wall rigidity syndrome in a routine bronchoscopy

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