Lindemann R
Department of Paediatrics, Ulleval University Hospital, Oslo, Norway.
Eur J Pediatr. 1998 Dec;157(12):1012-3. doi: 10.1007/s004310050988.
Fentanyl is in many neonatal intensive care units the sedative of choice. One side-effect is, however, the possibility of muscle and/or chest wall rigidity. A pregnant woman with a critical pulmonary valve stenosis had a balloon dilatation at 26 weeks of gestation. She was put on propranolol, but went into a severe cardiac failure. In week 31, she developed pregnancy induced hypertension. Periodically absent diastolic flow in the umbilical cord was demonstrated. A Caesarean section was performed using fentanyl as analgesia. A boy weighing 1440 g, had a 1 min Apgar score of 3 without respiratory movements. Mask ventilation was tried, but chest wall expansion was not achieved despite using high pressures. He was intubated and positive pressure ventilation attempted, with the same result. Despite the use of high pressures up to 60-70 cm H2O, no chest movement could be achieved. An intravenous line was established in order to give naloxone and pancuronium. Just before the drugs were given, chest wall movements were achieved and the heart rate normalized.
This is the first report on chest wall rigidity in a neonate after administration of fentanyl to the mother during Caesarean section.
在许多新生儿重症监护病房，芬太尼是首选的镇静剂。然而，其副作用之一是可能出现肌肉和/或胸壁僵硬。一名患有严重肺动脉瓣狭窄的孕妇在妊娠26周时接受了球囊扩张术。她服用了普萘洛尔，但出现了严重的心衰。在第31周时，她患上了妊娠高血压。脐动脉舒张末期血流间歇性消失。剖宫产时使用芬太尼作为镇痛剂。一名体重1440克的男婴，1分钟阿氏评分3分，无呼吸运动。尝试面罩通气，但尽管使用了高压力仍未实现胸壁扩张。对其进行插管并尝试正压通气，结果相同。尽管使用了高达60 - 70厘米水柱的高压力，仍无法实现胸壁运动。建立了静脉通路以便给予纳洛酮和潘库溴铵。就在给药前，实现了胸壁运动且心率恢复正常。
这是关于剖宫产时母亲使用芬太尼后新生儿出现胸壁僵硬的首例报告。
