Fentanyl-Induced Muscular Rigidity and Pulmonary Edema after Induction of General Anesthesia: A Case Report

病例報告：全身麻醉時 Fentanyl 引起的肌肉僵硬與肺水腫

馬振來(Chen-Lai Ma) ； 張錦新(Ching-Hsin Chang) ； 陳燿舜(Yiu-Sion Chen) ； 黃國生(Kuo-Sheng Huang) ； 文寄銘(Kee-Ming Man) ； 黃月萍(Yueh-Ping Huang) ； 張榞玲(Yuan-Ling Chang)

《童綜合醫學雜誌》 11卷1期 (2017/06) Pp. 44-49

摘要

We present and discuss a case of a 48-year-old woman who developed muscular rigidity and acute pulmonary edema after the administration of a lower dose of fentanyl as the primary agent during the induction of anesthesia. The patient experienced difficulty in breathing and could not be ventilated using an O_2 mask and was thus immediately administered a 1.5-mcg/kg bolus of fentanyl. Other clinical symptoms such as loss of consciousness, tight mouth closure, thoracoabdominal rigidity, and rapid peripheral capillary oxygen desaturation also developed in the present case. Airway compromise was treated by endotracheal tube intubation followed by an intravenous administration of thiamylal sodium (300 mg), rocuronium (50 mg), and propofol (100 mg). Acute pulmonary edema was diagnosed because there were observations such as high peak airway pressure, an ascending slope of graph on capnogram, chest auscultation with rales over bilateral lungs, and pink foamy secretions spilled over from the endotracheal tube. Postoperative plain chest X-ray confirmed the diagnosis of acute pulmonary edema. The patient had no history of asthma or any pulmonary or cardiac disease. The occurrence of pulmonary edema could only be explained as negative pressure pulmonary edema due to fentanyl-induced muscular rigidity that resulted in glottic closure with the involvement of all skeletal muscles. Opioid-induced muscle rigidity, although uncommon, may result in life-threatening respiratory compromise and requires a high level of suspicion and prompt intervention.

關鍵字

Anesthesia ； Opioids ； Muscular Rigidity ； Pulmonary Edema

並列摘要

一個48 歲女性病人在全身麻醉誘導時注射Fentanyl 引起肌肉僵硬與肺水腫。術後的胸部X 光片證實了肺水腫的診斷。依據過去病史，病人並無氣喘或其他肺部疾病。唯一可能的解釋是麻醉誘導時注射的Fentanyl 所致。Fentanyl 引起肌肉僵硬與肺水腫雖然罕見，但需靠麻醉醫師的高度警覺性，早期發現和及時處理，才能避免不良的後遺症。

並列關鍵字

麻醉 ； 鴉片類藥物 ； 肌肉僵硬 ； 肺水腫