Abstract | OBJECTIVE: CASE SUMMARY: A 2-day-old term neonate experienced generalized muscle rigidity and laryngeal spasm resulting in acute respiratory failure on 2 separate occasions after morphine administration. The first occasion was after administration of bolus doses of fentanyl and morphine 100 microg/kg in the operating theater; administration of intravenous propofol 2 mg/kg resulted in relief of muscle rigidity. The second occasion occurred a few hours later, when the patient received a continuous infusion of morphine 4.4 microg/kg/h in the intensive care unit and experienced generalized muscle rigidity with respiratory compromise. The opioid antagonist naloxone 30 microg/kg was administered intravenously, which immediately resulted in a patent airway and spontaneous breathing. An objective causality assessment using the Naranjo probability scale revealed that the likelihood of morphine causing the patient's muscle rigidity on the second occasion was highly probable to definite. It is not clear whether the first occurrence of muscle rigidity was morphine-induced. DISCUSSION: CONCLUSIONS: A serious adverse event consisting of generalized muscle rigidity and laryngospasm can occur after bolus administration of morphine as well as during continuous infusion. Clinicians should be aware of this possibility.
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Authors | Robin van der Lee, Ilse Ceelie, Saskia N de Wildt |
Journal | The Annals of pharmacotherapy
(Ann Pharmacother)
Vol. 43
Issue 10
Pg. 1724-6
(Oct 2009)
ISSN: 1542-6270 [Electronic] United States |
PMID | 19755623
(Publication Type: Case Reports, Journal Article)
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Chemical References |
- Analgesics, Opioid
- Narcotic Antagonists
- Naloxone
- Morphine
- Fentanyl
- Propofol
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Topics |
- Analgesics, Opioid
(adverse effects, therapeutic use)
- Fentanyl
(adverse effects, therapeutic use)
- Humans
- Infant, Newborn
- Male
- Morphine
(adverse effects, therapeutic use)
- Muscle Rigidity
(chemically induced)
- Naloxone
(therapeutic use)
- Narcotic Antagonists
(therapeutic use)
- Propofol
(therapeutic use)
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