A 40-year-old achondroplastic patient underwent posterior spinal fusion under general endotracheal anesthesia. Anesthesia was maintained with isoflurane, and sufentanil, dexmedetomidine, and lidocaine infusions. Urine output increased from 150 mL/hr to 950 mL/hr the fourth hour. An increasing serum sodium, low urine-specific gravity, and increased serum osmolarity occurred simultaneously with the polyuria. Within 2 hours of discontinuing the dexmedetomidine infusion urine output greatly decreased. Within 24 hours all signs of the polyuric syndrome resolved spontaneously. Alpha(2) agonists block arginine-vasopressin release and action; however, a polyuric syndrome has not been reported in the human literature.

P alonosetron is a new potent 5-hydroxytryptamine 3 (5-HT 3 )antagonist. Although this drug is thought to be more effective in preventing nausea and vomiting in patients receiving opioid-based patient-controlled analgesia (PCA) than other drugs in its class, clinical data are lacking. This study compared the effects of intravenously administered (IV) ondansetron and palonosetron administered at the end of surgery in preventing postoperative nausea and vomiting (PONV) in high-risk patients receiving IV PCA after thyroidectomy.A total of 100 female nonsmoking patients were randomly assigned to a palonosetron group or an ondansetron group. Ondansetron was given as an 8-mg bolus, and 16 mg was added to the IV PCA mixture. In the palonosetron group, 0.075 mg was injected as a bolus only. Fentanyl-based PCA was administered for 24 hours after the surgery. The incidence of PONV, severity of nausea, requirement for rescue antiemetics, and adverse effects were evaluated during 0 to 2 and 2 to 24 hours postoperatively.The incidence of PONV during the 24-hour postoperative interval was lower in the palonosetron group than in the ondansetron group (42% vs 62%, P = 0.045). No differences were observed, however, between the groups during the first 2 hours. Nonetheless, the incidence of PONV and nausea severity were substantially lower in the palonosetron group than in the ondansetron group during 2 to 24 hours (10% with palonosetron compared with 28% with ondansetron, P = 0.02). The investigators concluded that palonosetron is more effective than ondansetron for high-risk patients receiving fentanyl-based PCA after thyroidectomy, especially 2 to 24 hours after surgery.2. Kovac AL, Eberhart L, Kotorski J, et al. A randomized, double-blind study to evaluate the efficacy and safety of three different doses of palonosetron versus placebo in preventing nausea and vomiting over a 72-hour period.

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