Intraoperative Dexmedetomidine-Induced Polyuric Syndrome

Area of Science:

• Anesthesiology
• Neurosurgery
• Nephrology

Background:

• A 23-year-old male with a cervical spine fracture underwent complex spinal surgery.
• The patient received dexmedetomidine for sedation during fiberoptic intubation and general anesthesia was maintained with propofol and remifentanil.
• Intraoperative neuromonitoring included somatosensory and motor evoked potentials.

Observation:

• The patient exhibited a progressive increase in urine output during the nine-hour surgery, rising from 150 mL/hour to over 700 mL/hour.
• Postoperatively, urine output and laboratory values normalized within 24 hours.

Findings:

• The observed polyuria is a rare event in surgical patients under similar anesthetic conditions.
• Dexmedetomidine, an alpha-2 agonist, may inhibit arginine-vasopressin release, potentially causing increased urine production.

Implications:

• This case highlights a potential side effect of dexmedetomidine that warrants consideration in surgical settings.
• Further investigation into the mechanism and incidence of dexmedetomidine-induced polyuria is recommended.
• Clinicians should monitor fluid balance closely in patients receiving dexmedetomidine, especially during prolonged procedures.