Propofol Infusion and Green Urine

Bodenham, A.; Culank, L.S.; Park, G.R.

doi:10.1016/s0140-6736(87)91097-x

Cited by 63 publications

(36 citation statements)

References 2 publications

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“…Propofol is metabolized to phenolic metabolites through glucuronidation; green urine is attributed to these metabolites [1,2]. White or cloudy pink urine associated with propofol has been rarely reported in both the operating room and in intensive care unit [3][4][5].…”

Section: Discussionmentioning

confidence: 99%

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Cloudy urine developed during total intravenous anesthesia with 2% propofol in the patient taking hydroxyurea -A case report-

et al. 2017

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We report a case that a 68-year-old man taking hydroxyurea for essential thrombocythemia produced milky urine during propofol infusion. Under microscopic analysis, the cloudy urine sample was revealed to comprise uric acid crystals. Postoperatively, kidney function such as urine output and blood urea nitrogen to creatinine ratio showed no abnormality. We suggest that the cloudy urine may be due to the increased excretion of uric acid after administration of propofol. Although this rare case of cloudy milky urine is resolved on its own, we need to consider the possibility of such urine color changes. It is particularly important to understand that medication, preoperative serum uric acid level, urine pH, and the hypothermal operating room can change the color of urine through the presence of uric acid crystals. Although low urine pH and low temperature are known to increase the potential for urine discoloration after propofol administration, the incidence is very low. Furthermore, no cases of urine discoloration relating to the patient's medication have been reported. Here, we report on the development of cloudy urine during general anesthesia using total intravenous anesthesia (TIVA) with 2% propofol in a patient taking hydroxyurea. CASE REPORTA 68-year-old man with cervical herniated nucleus pulposus was scheduled for anterior cervical discectomy and fusion. The patient had been taking diltiazem and ramipril for hypertension, metformin for diabetes mellitus, and hydroxyurea for essential thrombocythemia. TIVA was planned as intraoperative motorevoked potentials monitoring was required. General anesthesia was induced and maintained with target controlled infusion of 2% propofol and remifentanil, in addition to neuromuscular blockade with rocuronium. Cloudy urine was observed 2 h after the initiation of anesthesia (Fig. 1). A urine sample was collected for analysis. Although the urine was cloudy, the drainage of urine was good and vital signs were within normal ranges. Therefore, we did not disrupt the operation and maintained anesthesia using TIVA while observing the urine.The color of urine became progressively clearer over time. In urine sample collected during anesthesia we observed crystals consistent with uric acid under the microscope (Fig. 2). Urine cultures were negative and renal function test results were within normal ranges. However, the serum uric acid level decreased from 6.3 mg/dl to 4.0 mg/dl postoperatively. The urine sample was subjected to a drug test, ultraperformance liquid chromatography-tandem mass spectrometry, and only ￭Case Report￭

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Section: Discussionmentioning

confidence: 99%

“…The presence of phenolic metabolites of propofol is known to cause green urine [1,2], while uric acid is believed to be responsible for other color changes [3][4][5].…”

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confidence: 99%

Cloudy urine developed during total intravenous anesthesia with 2% propofol in the patient taking hydroxyurea -A case report-

et al. 2017

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“…The green urine color due to Propofol is thought to be a result of its phenolic green metabolite produced in the liver and excreted in the urine. Standard urine analysis and urine cultures remain unremarkable [14][15][16][17]. This drug reaction is dose-dependent and usually appears after a continuous infusion of Propofol.…”

Section: Other Rare Side Effectsmentioning

confidence: 97%

Rare Side Effects of Propofol Administration—Case Report and a Brief Literature Review

Ismail¹,

Dimitrov²,

Mitsova³

et al. 2017

JPP

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Introduction: Propofol is an intravenous general anesthetic and sedation drug for use in the induction and maintenance of anesthesia or sedation. It is included in WHO Model List of Essential medicines and approved by the FDA (food and drug administration) in 1989. The side effects of Propofol have been studied widely in the last 25 years. They can be easily managed and that is why Propofol has become a first choice drug for the most of the anesthesiologists worldwide. This paper presents a case report of Propofol induced pulmonary edema and also a review of some of the rarest and unusual manifestations of Propofol side effects. Some of them are urine discoloration, tissue necrosis, rhabdomyolysis and postoperative pancreatitis. Methods and materials: A case summary of 18-years old woman with unusual postoperative pulmonary reaction was considered along with other documented cases. Several full-text articles were briefly analyzed for estimating the role of Propofol for a number of strange and potentially life threatening conditions. Results: Despite the low incidence rate, the presented case could be determined as a pulmonary edema due to its clinical features. Furthermore, rare drug reactions such as rhabdomyolysis, tissue necrosis, postoperative pancreatitis etc. may remain unrecognized and create diagnostic and therapeutic issues. Conclusions: Although the officially reported dangerous reaction, Propofol remains one of the best hypnotic and sedative agents. The better knowledge of the full list of drug reactions considered as rare and very rare is a guarantee of an adequate and a better therapeutic behavior.

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“…However, it can also be due to ingested substances or drugs, or related to the Foley catheter [1,2,3]. This case is of a 64-year-old male who developed green-colored urine secondary to propofol administration for the purpose of sedation in the intensive care unit.…”

Section: Abstract: Green Urine Propofolmentioning

confidence: 98%

“…Propofol is a commonly used intravenous drug for sedation in the operating room or intensive care. The green urine color due to propofol is thought to be a result of its phenolic green metabolite produced in the liver and excreted in the urine [2,4]. This green discoloration associated with propofol is benign, non-nephrotoxic, and reversible with drug discontinuation [1,2].…”

Section: Abstract: Green Urine Propofolmentioning

confidence: 99%