Green Urine after Propofol Infusion in the Intensive Care Unit

Lee, Min Jeong; Lee, Hyun Jeong; Kim, Jeong‐Min; Koh, Shin Ok; Kim, Eun Ho; Na, Sungwon

doi:10.4266/kjccm.2014.29.4.328

Cited by 3 publications

(2 citation statements)

References 15 publications

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“…Although a propofol is a commonly used sedative drug, many physicians are still unfamiliar with the propofol-induced green urine because of its rare incidence. The clinical features of the previous reports of propofol-induced green urine were variable including propofol infusion rate, total infused dose, duration, and patient characteristics [1][2][3][4][5][6][7][8][9][10][11].…”

Section: Discussionmentioning

confidence: 99%

“…However, urine discoloration after propofol infusion and its clinical association is not widely known to clinicians because of its rare occurrence. Although the exact incidence of propofol-induced green urine is unknown, reported incidence is suggested to be less than 1%.There have been only a few previous reports of this green discoloration of urine after propofol administration [1][2][3][4][5][6][7][8][9][10][11]. We experienced a 27-year-old man who showed green urine after two-staged repair of a thoraco-abdominal aortic aneurysm.…”

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Green urine after general anesthesia with propofol: different responses in the same patient -A case report-

Kim

Yoo

et al. 2017

Anesth Pain Med

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This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.Green discoloration of the urine after propofol administration is a rare clinical phenomenon. Although the exact incidence of propofol-induced green urine is not known, the reported incidence is thought to be less than 1%. In most reported cases of propofol-induced green urine, the clinical effects were benign and reversible. However, many clinicians are unfamiliar with this rare side effect of propofol. Here, we present the case of a patient who showed green urine following two-staged repair of a thoracoabdominal aortic aneurysm with propofol infusion. His urine had a normal yellowish color after the first operation, but appeared green immediately after the second surgery. Because propofol is a commonly used sedative agent, knowing that green urine can be attributed to propofol administration and that its clinical effect is mostly benign will help clinicians with patient management, as such knowledge will also reduce unnecessary concerns and laboratory tests. Propofol is a commonly used sedative agent for induction and maintenance of general anesthesia and for sedation in the intensive care unit (ICU). However, urine discoloration after propofol infusion and its clinical association is not widely known to clinicians because of its rare occurrence. Although the exact incidence of propofol-induced green urine is unknown, reported incidence is suggested to be less than 1%.There have been only a few previous reports of this green discoloration of urine after propofol administration [1][2][3][4][5][6][7][8][9][10][11]. We experienced a 27-year-old man who showed green urine after two-staged repair of a thoraco-abdominal aortic aneurysm. His urine color was normal yellowish color after the first infusion of propofol, but appeared green immediately after the second surgery with propofol administration. We report this case with a review of the relevant literature. the ICU and transferred to the general ward on postoperative day 2. During the time interval between the first and second operations, his systolic blood pressure and heart rate were controlled at 90 to 100 mmHg and around 90 bpm, respectively, with intermittent infusion of intravenous esmolol (50 g/kg/min) and/or nicardipine (1 g/kg/min). Intravenous famotidine, codein, and warfarin were also used occasionally. CASE REPORTHe was on oral carvedilol and losartan. During this time, the intraoperative and postoperative urine was normal yellowish.Seven days later, open repair of an abdominal aortic aneurysm was performed under the same TIVA technique. The intraoperative anesthetic and hemodynamic management was similar to that during the Bentall operation. Total anesthesia time was 4 hours and 42 minutes, with total propofol dosage of 2,100 mg. During this abdomin...

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Section: Discussionmentioning

confidence: 99%

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confidence: 89%

Green urine after general anesthesia with propofol: different responses in the same patient -A case report-

Kim

Yoo

et al. 2017

Anesth Pain Med

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Propofol-Associated Urine Discoloration: Systematic Literature Review

Lasica,

Cortesi,

Milani

et al. 2023

Pharmacology

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Introduction: Propofol occasionally induces a green or pink-cloudy urine discoloration. A lesser-known effect is green discoloration of hair, milk, liver, or stool. We aimed to gain insight into the features of these disturbances. Methods: The terms (“propofol” OR “fospropofol”) AND (“green” OR “pink” OR “cloudy” OR “pink-cloudy”) were searched in Excerpta Medica, MEDLINE/PubMed®, and Web of Sciences databases, with no language limit, from inception up to February 2023 (CRD4202236804). Articles reporting individually documented cases were retained, and data were extracted using a checklist. Results: Seventy-seven original reports documented 95 cases (including 13 subjects ≤18 years of age). Completeness of reporting was satisfactory in 33, good in 35, and excellent in 27 cases. Propofol-associated green urine discoloration was observed in 54 patients. In most instances (n = 21, 39%), propofol was given for ≥24 h. Sometimes, however, the urine discoloration developed after propofol for ≤3 h (n = 12, 22%). Propofol-associated urine discoloration was usually observed during the administration of this agent, but it was at times (n = 11) first recognized ≥3 h after propofol discontinuation. The duration of green urine discoloration was usually ≤24 h after stopping propofol. Propofol-associated green urine discoloration was never associated with worsening kidney function. A pink-cloudy urine discoloration was observed in 32 subjects with an acidic urine pH and increased uric acid excretion given propofol for ≤24 h. A stage I acute kidney injury was observed in 2 cases (6.3%) of propofol-associated pink-cloudy urine discoloration. Nine cases of non-urinary green discoloration were observed: hair (n = 4), breast milk (n = 1), liver (n = 1), stool (n = 1). Conclusion: Propofol is sometimes associated with a green (benign) or pink-cloudy (occasionally associated with mild acute kidney injury) urine discoloration. Rarely, non-urinary green discoloration has been reported.

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An unusual instance of propofol-triggered green urine in anesthesia management: A case report

Gonenavar,

Shukla,

Sridhar

et al. 2024

MGMJ

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Green urine is a rare and harmless side effect of propofol administration, occurring in less than 1% of cases. Urine discoloration following a single propofol bolus for induction of anesthesia is uncommon, benign, and entirely reversible upon cessation of propofol. Here, we present a case of green urine induced by a single dose (bolus) of propofol and discuss other potential endogenous and exogenous factors that could cause urine discoloration. Our case report aims to raise awareness among intensivists, physicians, and patients, helping to avoid unnecessary laboratory testing, initiating empirical broad-spectrum antibiotics, and anxiety associated with this unusual presentation.

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Green Urine after Propofol Infusion in the Intensive Care Unit

Cited by 3 publications

References 15 publications

Green urine after general anesthesia with propofol: different responses in the same patient -A case report-

Green urine after general anesthesia with propofol: different responses in the same patient -A case report-

Propofol-Associated Urine Discoloration: Systematic Literature Review

An unusual instance of propofol-triggered green urine in anesthesia management: A case report

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