Editing Fentanyl (section)

==== Wooden chest syndrome ====
A prominent idiosyncratic adverse effect of fentanyl also includes a sudden onset of rigidity of the abdominal muscles and the diaphragm, which induces respiratory failure; this is seen with high doses and is known as [[wooden chest syndrome]].<ref>{{cite book |vauthors=Chambers D, Huang CL, Matthews G |date=1 September 2019 |title=Basic Physiology for Anaesthetists |edition=2nd |chapter=Section 2 – Respiratory physiology: Chapter 25: Anaesthesia and the lung |orig-year=2015 |publisher=[[Cambridge University Press]] |publication-place=[[Cambridge]], UK |pages=107–110 |oclc=1088737571 |doi=10.1017/CBO9781139226394.027 |isbn=978-1-108-46399-7 |chapter-url=https://books.google.com/books?id=5ma8BQAAQBAJ&pg=PA107 |access-date=9 August 2021 |url=https://books.google.com/books?id=5ma8BQAAQBAJ |via=[[Google Books]] |archive-date=8 February 2023 |archive-url=https://web.archive.org/web/20230208191600/https://books.google.com/books?id=5ma8BQAAQBAJ |url-status=live }}</ref> The syndrome is believed to be the main cause of death as a result of fentanyl overdoses.<ref>{{cite journal | vauthors = Burns G, DeRienz RT, Baker DD, Casavant M, Spiller HA | title = Could chest wall rigidity be a factor in rapid death from illicit fentanyl abuse? | journal = Clinical Toxicology | volume = 54 | issue = 5 | pages = 420–423 | date = June 2016 | pmid = 26999038 | doi = 10.3109/15563650.2016.1157722 | publisher = [[American Academy of Clinical Toxicology|American Academy of Clinical Toxicology (AACT)]] / European Association of Poisons Centres and Clinical Toxicologist / [[Taylor & Francis]] | publication-place = [[McLean, Virginia|McLean]], [[Virginia (state)|VA]] | veditors = Seifert SA, Buckley N, Seger D, Thomas S, Caravati EM | s2cid = 23149685 | oclc = 8175535 }}</ref>

Wooden chest syndrome is reversed by naloxone and is believed to be caused by a release of [[noradrenaline]], which activates [[alpha-adrenergic receptors|α-adrenergic receptors]] and also possibly via activation of [[Acetylcholine receptors|cholinergic receptors]].<ref name="Torralva">{{cite journal | vauthors = Torralva R, Janowsky A | title = Noradrenergic Mechanisms in Fentanyl-Mediated Rapid Death Explain Failure of Naloxone in the Opioid Crisis | journal = The Journal of Pharmacology and Experimental Therapeutics | volume = 371 | issue = 2 | pages = 453–475 | date = November 2019 | pmid = 31492824 | pmc = 6863461 | doi = 10.1124/jpet.119.258566 | url = https://jpet.aspetjournals.org/content/jpet/371/2/453.full-text.pdf | access-date = 9 August 2021 | publisher = [[American Society for Pharmacology and Experimental Therapeutics]] | publication-place = [[Rockville, Maryland|Rockville]], [[Maryland]], United States of America | oclc = 1606914 | veditors = Trew KD, Dodenhoff R, Vore M, Siuciak JA, Perry J, Wood C, Blumer J | archive-url = https://web.archive.org/web/20200309222939/https://jpet.aspetjournals.org/content/jpet/371/2/453.full-text.pdf | archive-date = 9 March 2020 | lccn = sf80000806 }}</ref>

Wooden chest syndrome is unique to the most powerful opioids{{mdash}}which today comprise fentanyl and its analogs{{mdash}}while other less-powerful opioids like heroin produce mild rigidity of the respiratory muscles to a much lesser degree.<ref>{{cite journal |title=Chest wall rigidity in fentanyl abuse: illicit fentanyl could be a major factor in sudden onset of this potentially lethal adverse event |access-date=9 August 2021 |vauthors=Petrou I |date=1 September 2016 |volume=33 |issue=9 |journal=Contemporary Pedriatics |publisher=Intellisphere, LLC./ MJH Life Sciences (Multimedia Medical LLC) |issn=8750-0507 |publication-place=[[Cranbury, New Jersey|Cranbury]], [[New Jersey]], United States of America |via=Gale Academic OneFile |url-access=subscription |url=https://link.gale.com/apps/doc/A464982083/AONE?u=anon~4087cc99 |oclc=10956598 |veditors=Levine L, Tan TQ, Shippoli J }}{{Dead link|date=February 2023 |bot=InternetArchiveBot |fix-attempted=yes }}</ref><ref name="Torralva" />