Polyuria Related to Dexmedetomidine

Analysis of factors associated with polyuria in spinal surgery: a retrospective study

BACKGROUND

Intraoperative urine output monitoring is an important indicator to judge patient volume, and perioperative polyuria can lead to a variety of complications, which seriously affect the quality of prognosis of patients. Previous studies have found that intraoperative polyuria in some patients may be associated with the use of anesthetic drugs, especially in spinal surgery patients, where cases of polyuria have been reported more commonly. Therefore, this retrospective study focused on the factors influencing polyuria during spinal surgery.

METHODS

Data from spine surgery patients in the Madison system of Tongji Hospital from September 2018 to December 2021 were collected. The age, sex, BMI, surgical information, preoperative and postoperative test results, LOS, and postoperative adverse reactions were extracted. The relevant data during the operation were recorded through the Madison system at the same time, including the time statistics of various types of surgery, the amount of liquid in and out of the operation, the use of anesthetic drugs, the use of vasoactive medications, and the results of blood gas analysis. The primary outcome was to analyze the factors influencing intraoperative polyuria. Secondary outcomes were analyzed, among adverse effects of intraoperative polyuria, etc. RESULTS: Among the 903 included patient data, we concluded that the factors influencing intraoperative polyuria were female (OR, 1.933, 95% CI, 1.457-2.565), dexmedetomidine (OR, 1.876, 95% CI, 1.338-2.631), dopamine (OR, 1.413, 95% CI, 1.406-1.910). At the same time, different surgical sites also affected the symptoms of polyuria (p < 0.001). Intraoperative polyuria symptoms led to an increase in the incidence of infection (p < 0.05) and secondary surgery (p < 0.05). The length of hospital stay was also increased (p < 0.05) compared with the normal urine output group. There was no significant difference in the time of operation and preoperative and postoperative examination information(p > 0.05).

CONCLUSIONS

Females, dexmedetomidine, dopamine may be risk factors for intraoperative polyuria. Intraoperative polyuria will lead to various postoperative adverse reactions, increasing the proportion of postoperative infection and secondary surgery.

Establishment and validation of a predictive nomogram for polyuria during general anesthesia in thoracic surgery

BACKGROUND

To develop and evaluate a predictive nomogram for polyuria during general anesthesia in thoracic surgery.

METHODS

A retrospective study was designed and performed. The whole dataset was used to develop the predictive nomogram and used a stepwise algorithm to screen variables. The stepwise algorithm was based on Akaike's information criterion (AIC). Multivariable logistic regression analysis was used to develop the nomogram. The receiver operating characteristic (ROC) curve was used to evaluate the model's discrimination ability. The Hosmer-Lemeshow (HL) test was performed to check if the model was well calibrated. Decision curve analysis (DCA) was performed to measure the nomogram's clinical usefulness and net benefits. P < 0.05 was considered to indicate statistical significance.

RESULTS

The sample included 529 subjects who had undergone thoracic surgery. Fentanyl use, gender, the difference between mean arterial pressure at admission and before the operation, operation type, total amount of fluids and blood products transfused, blood loss, vasopressor, and cisatracurium use were identified as predictors and incorporated into the nomogram. The nomogram showed good discrimination ability on the receiver operating characteristic curve (0.6937) and is well calibrated using the Hosmer-Lemeshow test. Decision curve analysis demonstrated that the nomogram was clinically useful.

CONCLUSIONS

Individualized and precise prediction of intraoperative polyuria allows for better anesthesia management and early prevention optimization.

Probable Dexmedetomidine Induced Diabetes Insipidus: A Case Review

What is known and objective: Despite increased use of dexmedetomidine as a light sedative in the ICU setting, diabetes insipidus (DI) secondary to a dexmedetomidine infusion has rarely been reported. Case summary: We present a 32-year-old male admitted to the surgical intensive care unit (ICU) with 50% total body surface area burn. A short time following initiation (0.2 mcg/kg/hr) and up-titration (0.8 mcg/kg/hr) of dexmedetomidine continuous infusion, the patient developed DI, eventually exceeding 3 L of urine within a 6-hour timeframe. Excessive polyuria also led to significant electrolyte shifts (serum sodium 156 mmol/L and serum potassium < 1.8 mmol/L), resulting in Torsade's de Pointes. What is new and conclusion: Our case discusses diabetes insipidus leading to severe electrolyte abnormalities secondary to dexmedetomidine.

Intraoperative dexmedetomidine-induced polyuria from a loading dose: a case report

With extensive perioperative use of dexmedetomidine, there has been rising concern about its side effects, which are most commonly bradycardia and hypotension. However, increased urine output or diuresis is not well recognized with perioperative use of dexmedetomidine. We report a case of intraoperative polyuria induced by dexmedetomidine. The unusual feature of this case is that only a loading dose of dexmedetomidine was administered, but there was a long-lasting and large effect of diuresis. The findings from our case suggest that clinicians should be alert to the risk of diuresis when using dexmedetomidine.

Perioperative Diabetes Insipidus Caused by Anesthetic Medications: A Review of the Literature

Diabetes insipidus (DI) is an uncommon perioperative complication that can occur secondary to medications or surgical manipulation and can cause significant hypovolemia and electrolyte abnormalities. We reviewed and evaluated the current literature and identified 24 cases of DI related to medications commonly used in anesthesia such as propofol, dexmedetomidine, sevoflurane, ketamine, and opioids. This review summarizes the case reports and frequency of DI with each medication and presents possible pathophysiology. Medication-induced DI should be included in the differential diagnosis when intraoperative polyuria is identified. Early identification, removal of the agent, and treatment of intraoperative DI are critical to minimize complications.

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

Excessive urination can be a perioperative challenge for providers due to the possibility of secondary hypernatremia. Dexmedetomidine has previously been reported by several groups to induce a polyuric-like syndrome; however, the exact mechanism in humans remains unclear. In this report, we discuss a case of intraoperative, transient dexmedetomidine bolus-induced excessive urination and suggest a potential mechanism by which this may occur in a subset of the population.

Cardiovascular and renal effects of constant rate infusions of remifentanil, dexmedetomidine and their combination in dogs anesthetized with sevoflurane

We evaluated changes in cardiovascular and renal functions as well as arginine vasopressin (AVP) secretion, with remifentanil and dexmedetomidine administration alone or in combination in sevoflurane-anesthetized dogs. Six healthy adult Beagle dogs received one of the following four treatments in a randomized crossover study: saline (C), remifentanil alone at successively increasing doses (R; 0.15, 0.60, and 2.40 µg/kg/min), dexmedetomidine alone (D; 0.5 µg/kg intravenously for initial 10 min followed by a constant rate infusion at 0.5 µg/kg/hr), and a combination of remifentanil and dexmedetomidine at the above-mentioned doses (RD). Sevoflurane doses were adjusted to 1.5 times of minimum alveolar concentration (MAC) equivalent according to MAC-sparing effects with remifentanil and dexmedetomidine as previously reported. Cardiovascular measurements, renal function data, and plasma AVP concentrations were determined before and every 60 min until 180 min after drug administration as per each treatment. In the R, D and RD, heart rate significantly decreased and mean arterial pressure significantly increased from baseline or with C. Cardiac index significantly decreased and systemic vascular resistance index increased with D and RD. Oxygen extraction ratio, renal blood flow, and glomerular filtration rate were not affected. The plasma AVP concentrations significantly decreased in D and RD, but increased in R. Only in D, the natriuresis was elicited. The combination of remifentanil and dexmedetomidine in sevoflurane-anesthetized dogs was acceptable in terms of the hemodynamics, oxygenation, and renal function. Remifentanil may interfere with dexmedetomidine-induced diuresis and inhibition of AVP secretion.

Severe Disruption of Water and Electrolyte Balance After Appendectomy: A Case Report

Perioperative derangements of fluid and electrolyte homeostasis are rare complications in healthy children. Nonetheless, early diagnosis and treatment are mandatory to avoid a potentially life-threatening situation. However, the variety of underlying pathologies may prove to make accurate diagnosis challenging. This case report presents the management of an unexpected occurrence of a perioperative partial diabetes insipidus with massive fluid loss. Diagnostic and therapeutic procedures are discussed in the context of laboratory findings, and an overview of the existing literature is given. Finally, we emphasize that a multidisciplinary approach is most appropriate for diagnosis, accurate treatment, and follow-up of the patient.

Intraoperative Dexmedetomidine-Induced Polyuric Syndrome

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.

Central diabetes insipidus following cardiopulmonary arrest in a dog

OBJECTIVE

To describe a clinical case of transient central diabetes insipidus (CDI) occurring post cardiopulmonary arrest (CPA) in a dog.

CASE SUMMARY

An 8-week-old dog presented for intensive care after successful resuscitation following CPA. The patient exhibited neurologic deficits at initial presentation and over the following days developed marked polyuria, isosthenuria, and low urine osmolality. Treatment with synthetic vasopressin resulted in a reduction in urine output, increase in urine specific gravity (>50%), and increase in urine osmolality, suggesting a diagnosis of partial CDI. Clinical signs resolved over the following weeks and treatment was discontinued.

NEW OR UNIQUE INFORMATION PROVIDED

CPA has been described as a cause of ischemic injury to the pituitary gland resulting in CDI in people. To the authors' knowledge, this is the first report of a dog developing transient partial CDI following CPA and successful resuscitation.