Is possible chest wall rigidity after illicit intravenous fentanyl administration clinically significant?

3 out of 5 stars Could chest wall rigidity be a factor in rapid deaths from illicit fentanyl abuse? Burns G et al. Clin Toxicol 2016 Mar 21 [Epub ahead of print] Abstract “Wooden chest syndrome” describes marked muscle rigidity — especially involving the thoracic and abdominal muscles — that is an occasional adverse effect associated with the intravenous administration of lipophilic synthetic opioids such as fentanyl. It can make ventilation difficult, and seems to be reversed by naloxone. The authors of this interesting speculative paper hypothesized that chest wall rigidity might be at least partially responsible for some deaths related to intravenous injection of fentanyl, which increasingly is appearing in samples of heroin. To investigate this theory, they examined forensic data from all lethal fentanyl intoxications in Franklin County, Ohio over 9 months in 2015. They identified 48 such deaths. Intravenous administration was confirmed in 23 cases and suspected in 22 others; 3 exposures were by ingestion. Fifteen of the cases had “undetectable” (< 0.5 ng/ml) of the metabolite norfentanyl, which the authors say suggests death was nearly immediate. In 2 cases, EMT documents suggest that manual ventilation was difficult until naloxone was administered. The conclusion: [W]e believe sudden onset chest wall rigidity may be a significant and previously unreported factor leading to an increased mortality, from illicit IV fentanyl use. The authors ...
Source: The Poison Review - Category: Toxicology Authors: Tags: Medical chest wall rigidity fentanyl wooden chest Source Type: news