Intraoperative Dexmedetomidine-Induced Polyuric Syndrome

Abstract

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.

Anesthetic agents affect urodynamic parameters and anesthetic depth at doses necessary to facilitate preclinical testing in felines

“…1a) were strongly correlated with prolonged anesthesia (isoflurane [2-6 hours before CMG trials, 8-10 hours total], followed by α-chloralose [12-22 hours before CMG trials]) and repeated bladder fills for other experimental objectives. Although we did not see significant differences between survival agents, dexmedetomidine has been reported to cause polyuria through blockage of arginine-vasopressin release 22,23 .…”

Transient Dexmedetomidine Bolus-Induced Excessive Urination Intraoperatively in a 68-Year-Old Male

“…It achieves this by increasing the activity of gamma-aminobutyric acid (GABA) neurons in the ventrolateral preoptic nucleus of the brain [ 1 ]. Side effects of this medication include hypotension, bradycardia, or dry mouth [ 2 ]; however, it is reported by several groups that dexmedetomidine may also induce polyuric syndrome in some patients [ 1 , 3 – 6 ]. It is believed that this occurs through the inhibition of arginine-vasopressin (AVP) release [ 6 ].…”

“…Side effects of this medication include hypotension, bradycardia, or dry mouth [ 2 ]; however, it is reported by several groups that dexmedetomidine may also induce polyuric syndrome in some patients [ 1 , 3 – 6 ]. It is believed that this occurs through the inhibition of arginine-vasopressin (AVP) release [ 6 ]. Written consent, in accordance with the Health Insurance Portability and Accountability Act (HIPPA), was obtained.…”

Re: Birder LA, Wolf‐Johnston AS, Jackson EK, Wein AJ, Dmochowski R. Aging increases the expression of vasopressin receptors in both the kidney and urinary bladder. Neurourol Urodyn. 2019 Jan;38(1):393–397

“…Based on the results of the authors in addition to the recent validation that in patients taking VR antagonists the inability to concentrate urine sufficiently, that is, osmolar excretion, appears to be the major determinant of polyuria we consider to check routinely for urine osmolarity and to evaluate efficacy of desmopressin in the above characterized patients.…”