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HOME > Acute Crit Care > Volume 27(3); 2012 > Article
Case Report Muscular Rigidity and Pulmonary Edema Following Administration of Low Dose Fentanyl: A Case Report
Sung Kyu Rim, Jong Il Kim, Yu Bin Son, Ji Heui Lee

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Department of Anesthesiology and Pain Medicine, Korea Institute of Radiological and Medical Science, Seoul, Korea.

Fentanyl-induced muscular rigidity has been reported exclusively in patients when large fentanyl dosages were employed in the operating room or in the pediatric intensive care unit. Rigidity and pulmonary edema after analgesic doses of fentanyl had not been reported previously. A 25-year-old man underwent removal of a foreign body and application of an Ilizarov frame of tibia under general anesthesia. The patient received 100 microg of fentanyl during emergence of anesthesia and the procedure of dressing. On arrival to the anesthetic recovery room, the patient presented with muscular rigidity and about 1 hour later, developed pulmonary edema. The notable predisposing factors were rapid injection of fentanyl and history of treatment with antidepressants and haloperidol, modifiers of serotonin and dopamine levels. From this case, we suggest the need for careful observation for the development of muscle rigidity complicating airway management in patients taking antidepressants and antipsychotics, especially after administration of an analgesic dose of fentanyl.

ACC : Acute and Critical Care