Uric Acid Excretion Increases During Propofol Anesthesia

Masuda, Akira; Asahi, Takeshi; Sakamaki, Midori; Nakamaru, Katsuhito; Hirota, Koki; Ito, Yusuke

doi:10.1097/00000539-199707000-00026

Cited by 20 publications

(18 citation statements)

References 6 publications

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“…[18] Propofol increases urine uric acid excretion and is beneficial for such patients. [19] Succinylcholine is preferably avoided because of abnormal potassium influx. [20] Atracurium is safe for muscle relaxation.…”

Section: Discussionmentioning

confidence: 99%

An unanticipated difficult airway in Lesch-Nyhan syndrome

Salhotra¹,

Sharma²,

Tyagi³

et al. 2012

J Anaesthesiol Clin Pharmacol

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An 11-year-old boy with Lesch–Nyhan syndrome presented to the emergency for fixation of a fractured femur. During induction of general anesthesia, unexpected difficult intubation was encountered with a 6.5-mm ID endotracheal tube and successively smaller tubes, also failing to pass 1 cm beyond the vocal cords. Intubation was finally achieved with a 4.5-mm ID tube. The surgery was completed uneventfully. A tracheal diverticulum was found in the computerized tomography (CT) scan performed postoperatively to account for this unexpected difficult intubation. This case highlights the anesthetic concerns in Lesch-Nyhan syndrome and also reports the rare occurrence of a tracheal diverticulum associated with it.

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Section: Discussionmentioning

confidence: 99%

An unanticipated difficult airway in Lesch-Nyhan syndrome

Salhotra¹,

Sharma²,

Tyagi³

et al. 2012

J Anaesthesiol Clin Pharmacol

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“…Masuda et al [6] observed that uric acid excretion increased during anesthesia using propofol by inhibiting uric acid reabsorption similar to probenecid. Therefore, increased uric acid excretion due to the administration of propofol is believed to be an important factor in urine color changes.…”

Section: Discussionmentioning

confidence: 99%

“…Not all patients administred propofol exhibit urine discoloration. Masuda et al [6] suggested that crystal development is closely related to urine pH and temperature, in addition to urine uric acid concentration. It is known that uric acid is precipitated in an acidic urine pH and at low temperature.…”

Section: Discussionmentioning

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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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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“…Masuda et al .,[6] in their study of 23 patients, performed a urine analysis of all patients undergoing surgeries with TIVA ( n =11) and sevoflurane ( n =12) anaesthesia. They inferred that all patients on TIVA had increased urine uric acid.…”

mentioning

confidence: 99%

“…Milky color urine is observed more frequently in operation theatres with ambient temperature less than 24°C. [6] The reason attributed to this is that decreased temperature causes decreased solubility to uric acid crystals.…”

mentioning

confidence: 99%