Dewhirst E, Naguib A, Tobias J. Chest Wall Rigidity in Two Infants After Low-Dose Fentanyl Administration. Peds Emerg Care, Vol 28(5); May 2012: 465-468

Chest wall rigidity is one of the most feared complications of fentanyl administration in all ages. This is a rare occurrence in children but multiple studies have documented hypoventilation and hypoxia associated with chest wall rigidity in children receiving either rapid IV fentanyl administration or high fentanyl doses.

This article presents two neonates who developed this complication after standard fentanyl dosing. Intransal fentanyl is now a popular form of effective, immediate analgesia; while no cases of chest wall rigidity have been yet documented, providers must be prepared for this complication especially in neonates and infants.

This article highlights the risk of this complication in young patients, and stresses the need for access to naloxone initially (which usually works), as well as bag-mask devices, neuromuscular paralyzing agents and endotracheal intubation capability whenever fentanyl is administered.