Fentanyl-Induced Rigid Chest Syndrome (FIRCS, Wooden Chest Syndrome) is a rare condition usually associated with anesthesia or sedation.
Pathogenesis: binding of opioid to mu receptors in the CNS with activation of a dopaminergic pathway, resulting in prolonged skeletal muscle contraction
Clinical features:
(1) pronounced abdominal and thoracic rigidity
(2) asynchronous ventilation
(3) respiratory failure
(4) responds to narcotic reversal with naloxone
It has been most often reported for fentanyl but also can occur with methadone.
It may:
(1) occur during surgical anesthesia or procedural sedation
(2) encountered in mechanically ventilated patients in the ICU
(3) occur during an overdose
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