Intraoperative Polyuria as a Possible Complication of Anesthetic Agents and Spinal Procedures: A Case Series

Intraoperative polyuria, defined as urine output >2.5 mL/kg/hour during surgical procedures, can complicate fluid and electrolyte management. This series reviews cases of intraoperative polyuria in patients undergoing general anesthesia for spinal procedures. Urine output ranged from 2.69 to 3.69 mL/kg/hour during these procedures, which lasted from 8.5 to 12.5 hours. Dexmedetomidine, sevoflurane, ketamine, and/or propofol were used. Existing literature points to associations between these agents and transient arginine vasopressin (AVP) disorders that cause polyuria. All cases occurred in the setting of spinal procedures, which have also been associated with AVP disorders. The combination of multiple factors during surgical procedures that may increase the risk of AVP disorders has the potential to increase the incidence of intraoperative polyuria. None of the patients had a history of diabetes or AVP disorders, and no other causes of polyuria were identified. Awareness of the link between anesthetic medications, spinal procedures, and polyuria can improve the diagnosis and management of intraoperative polyuria.