Reversal of chest wall rigidity at induction in a patient with fentanyl-induced rigidity should be achieved with which agent?

Reversal of chest wall rigidity at induction in a patient with fentanyl-induced rigidity should be achieved with which agent?

• A. Flumazenil
• B. Naloxone
• C. Succinylcholine
• D. Albuterol

Answer: (C)

Fentanyl-induced chest wall rigidity is a rapid, central-meditated increase in thoracic and airway muscle tone that can block ventilation during induction. The quickest way to overcome this is to provide immediate skeletal muscle relaxation with a fast-acting neuromuscular blocker. Succinylcholine fits perfectly here because it acts within seconds and wears off relatively quickly, giving you rapid relaxation of the chest wall and laryngeal muscles to allow ventilation and airway management. Flumazenil would reverse benzodiazepine effects, not fentanyl-induced rigidity. Naloxone reverses opioid effects generally, but it may not reliably and promptly relieve the specific rigid response and can cause other early reversal effects like agitation or hypertension. Albuterol addresses bronchospasm, not the generalized muscle rigidity of the chest wall. If succinylcholine isn’t suitable, a rapid nondepolarizing agent (such as rocuronium) might be used as an alternative to achieve quick relaxation, but succinylcholine remains the classic choice for immediate reversal of this rigidity.

Fentanyl-induced chest wall rigidity is a rapid, central-meditated increase in thoracic and airway muscle tone that can block ventilation during induction. The quickest way to overcome this is to provide immediate skeletal muscle relaxation with a fast-acting neuromuscular blocker. Succinylcholine fits perfectly here because it acts within seconds and wears off relatively quickly, giving you rapid relaxation of the chest wall and laryngeal muscles to allow ventilation and airway management.

Flumazenil would reverse benzodiazepine effects, not fentanyl-induced rigidity. Naloxone reverses opioid effects generally, but it may not reliably and promptly relieve the specific rigid response and can cause other early reversal effects like agitation or hypertension. Albuterol addresses bronchospasm, not the generalized muscle rigidity of the chest wall. If succinylcholine isn’t suitable, a rapid nondepolarizing agent (such as rocuronium) might be used as an alternative to achieve quick relaxation, but succinylcholine remains the classic choice for immediate reversal of this rigidity.