Apparent Dexmedetomidine-Induced Polyuric Syndrome in an Achondroplastic Patient Undergoing Posterior Spinal Fusion

Greening, Allison; Mathews, Letha; Blair, J. W.

doi:10.1213/ane.0b013e31823299c1

Cited by 18 publications

(15 citation statements)

References 7 publications

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“…Pratt, et al reported a medical case in which a patient received a multiple day infusion of dexmedetomidine for sedation [6]. The other three reported cases involve patient from spine surgery with an age range from 12 to 71 years [7-9]. The doses used in these cases were less than 1 mcg/kg/hour, and none of these cases used a loading dose.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Dexmedetomidine-Induced Polyuric Syndrome

Granger

Ninan

2017

Cureus

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A 23-year-old male trauma patient with a cervical spine fracture underwent an anterior and posterior discectomy and spinal fusion surgery. The patient presented to the operating room with a stabilizing halo fixation device in place, and a fiberoptic intubation was performed with dexmedetomidine for sedation. During the surgical procedure, general anesthesia was maintained with a propofol and remifentanil infusion as the patient was monitored using somatosensory and motor evoked potentials. The patient's urine output increased gradually during the nine-hour surgical procedure from 150 mL/hour to over 700 mL/hour in the eighth hour of the procedure, where it remained until the end of the procedure. Postoperatively, the patient's laboratory values and urine output returned to baseline levels the following day. A search of the literature revealed few case reports of polyuria under similar conditions. Dexmedetomidine, being an alpha-2 agonist that blocks arginine-vasopressin release, may be responsible for inducing the polyuria noted in this patient case.

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Section: Discussionmentioning

confidence: 99%

Intraoperative Dexmedetomidine-Induced Polyuric Syndrome

Granger

Ninan

2017

Cureus

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“…An increasing serum sodium, low urine specific gravity, and increased serum osmolarity occurred simultaneously with the polyuria. Within 2 h of discontinuing the DEX infusion, urine output greatly decreased, and all signs of the polyuric syndrome resolved spontaneously in 24 h. 115 Despite the diuretic effect of DEX in adults, the 74% increase in urinary output that has been seen for up to 4 h after cardiac surgery does not affect renal function when compared with placebo in a double-blind design. 116 There are some data to support a renoprotective effect of DEX.…”

Section: Effect Of Dexmedetomidine On the Kidneymentioning

confidence: 96%

Dexmedetomidine: review, update, and future considerations of paediatric perioperative and periprocedural applications and limitations

Mahmoud

Mason

2015

British Journal of Anaesthesia

292

251

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Despite lack of paediatric labelling, contributions to the literature on paediatric applications of dexmedetomidine have increased over recent years. Dexmedetomidine possesses many properties that are advantageous for a sedative and anaesthetic; it has been reported to provide sedation that parallels natural sleep, anxiolysis, analgesia, sympatholysis, and an anaesthetic-sparing effect with minimal respiratory depression. In addition, there is increasing evidence supporting its organ-protective effects against ischaemic and hypoxic injury. These favourable physiological effects combined with a limited adverse effect profile make dexmedetomidine an attractive adjunct to anaesthesia (general and regional) for a variety of procedures in paediatric operating rooms. A comprehensive understanding of the pharmacological, pharmacokinetic, and pharmacodynamic effects of dexmedetomidine is critical to maximize its safe, efficacious, and efficient paediatric perioperative applications. This review focuses on the current paediatric perioperative and periprocedural applications of dexmedetomidine and its limitations, with a consideration for the future.

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“…One human case report described an increase in urine output and serum sodium concentration after 4 hours in a patient undergoing 6 hours surgical procedure who was receiving dexmedetomidine at a dose of 0.5 μg/kg/h. Upon discontinuing the dexmedetomidine, urine output normalized once the patient was admitted to the ICU for recovery . Another human case report described polyuria with dexmedetomidine doses over 1 μg/kg/h without changes in serum osmolality, serum sodium, or USG.…”

Section: Discussionmentioning

confidence: 99%

“…Upon discontinuing the dexmedetomidine, urine output normalized once the patient was admitted to the ICU for recovery. 23 Another human case report described polyuria with dexmedetomidine doses over 1 g/kg/h without changes in serum osmolality, serum sodium, or USG. This was attributed to the fact that this patient was receiving 0.45% NaCl with 5% dextrose at the time so it was presumed that hypotonic losses were matched.…”

Section: Discussionmentioning

confidence: 99%