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Lasica A, Cortesi C, Milani GP, Bianchetti MG, Schera FM, Camozzi P, Lava SAG. Propofol-Associated Urine Discoloration: Systematic Literature Review. Pharmacology 2023; 108:415-422. [PMID: 37634493 DOI: 10.1159/000533327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 07/26/2023] [Indexed: 08/29/2023]
Abstract
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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Affiliation(s)
- Ana Lasica
- Family Medicine, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Cinzia Cortesi
- Pediatric Anesthesia, Institute of Pediatrics of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Gregorio P Milani
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Mario G Bianchetti
- Family Medicine, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Federica M Schera
- Family Medicine, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Pietro Camozzi
- Department of Anesthesia, Hôpital du Valais, Sion, Switzerland
| | - Sebastiano A G Lava
- Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
- Clinical Pharmacology and Therapeutics Group, University College London, London, UK
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Rainone A, Delucilla L, Elofer S, Bensimon L, Abittan G. Propofol-Induced Green Breast Milk: A Case Report. Can J Hosp Pharm 2018; 71:389-391. [PMID: 30626986 PMCID: PMC6306180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Anthony Rainone
- , PharmD, MSc(Immunol), is a Master of Science candidate with the Faculté de pharmacie, Université de Montréal, and a Pharmacy Resident at the Sir Mortimer B Davis Jewish General Hospital, Montréal, Quebec
| | - Laura Delucilla
- , PharmD, is a Master of Science candidate with the Faculté de pharmacie, Université de Montréal, and a Pharmacy Resident at the McGill University Health Centre, Montréal, Quebec
| | - Stéphanie Elofer
- , PharmD, is a Master of Science candidate with the Faculté de pharmacie, Université de Montréal, and a Pharmacy Resident at Hôpital de la Cité-de-la-Santé, Laval, Quebec
| | - Leah Bensimon
- , PharmD, MSc, was, at the time of this study, with the Palm Beach Medical Center, West Palm Beach, Florida. She is now Medical Affairs Associate at Promius Pharma LLC, Princeton, New Jersey
| | - Gaëlle Abittan
- , BPharm, MSc, is Assistant to the Chief Pharmacist at the CIUSSS Centre-Ouest-de-l'Île-de-Montréal, Montréal, Quebec
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Lundbye J, Lyden PD, Polderman KH, Schwab S. Clinical Studies Targeting Stroke and Ischemic Insults. Ther Hypothermia Temp Manag 2018; 7:12-15. [PMID: 28253089 DOI: 10.1089/ther.2016.29022.jjl] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Justin Lundbye
- 1 Hospital of Central Connecticut , New Britain, Connecticut
| | - Patrick D Lyden
- 2 Department of Neurology, Cedars-Medical Center , Los Angeles, California
| | - Kees H Polderman
- 3 Department of Critical Care, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania
| | - Stefan Schwab
- 4 Department of Neurology, Friedrich-Alexander University , Erlangen, Germany
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Choudhury P, Mohapatra A, Sanghi S. Common anaesthetic agent causing an uncommon side effect. BMJ Case Rep 2018; 2018:bcr-2018-225126. [DOI: 10.1136/bcr-2018-225126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Kim GE, Kim DY, Yoo DK, Lee JH, Lee SM, Min JJ. Green urine after general anesthesia with propofol: different responses in the same patient -A case report-. Anesth Pain Med (Seoul) 2017. [DOI: 10.17085/apm.2017.12.1.32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Go Eun Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dae Yoon Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doek Kyu Yoo
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Hwan Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sangmin Maria Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Jin Min
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Lundbye J, Lyden PD, Polderman KH, Schwab S. Clinical Studies Targeting Stroke and Ischemic Insults. Ther Hypothermia Temp Manag 2017:ther.2016.29022.jjl.rev. [PMID: 28106522 DOI: 10.1089/ther.2016.29022.jjl.rev] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Justin Lundbye
- 1 The Greater Waterbury Health Network, Waterbury, Connecticut
| | - Patrick D Lyden
- 2 Department of Neurology, Cedars-Medical Center , Los Angeles, California
| | - Kees H Polderman
- 3 Department of Critical Care, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania
| | - Stefan Schwab
- 4 Department of Neurology, Friedrich-Alexander University , Erlangen, Germany
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Prakash S, Saini S, Mullick P, Pawar M. Green urine: A cause for concern? J Anaesthesiol Clin Pharmacol 2017; 33:128-130. [PMID: 28413291 PMCID: PMC5374818 DOI: 10.4103/0970-9185.202190] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Smita Prakash
- Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
| | - Suman Saini
- Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
| | - Parul Mullick
- Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
| | - Mridula Pawar
- Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
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Fujii-Abe K, Kawahara H, Fukayama H. An analysis of green discoloration of urine caused by propofol infusion. J Clin Anesth 2016; 35:358-360. [PMID: 27871556 DOI: 10.1016/j.jclinane.2016.08.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 07/14/2016] [Accepted: 08/09/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Propofol is a short-acting, intravenous sedative-hypnotic agent that is widely used for the induction and maintenance of general anesthesia and sedation. An uncommon adverse effect of propofol is green discoloration of the urine, which has been reported not only under general anesthesia but also with sedation. Although it is assumed that the phenolic derivatives of propofol can cause green discoloration of the urine, the actual origin remains unknown. The aim of this report was to identify the origin of the green discoloration of the urine using liquid chromatography-mass spectrometry (LC-MS). CLINICAL FEATURES The patient, a 51-year-old man, was scheduled for his oral surgery under general anesthesia using propofol. Postoperatively, the color of his urine was observed to be green. We compared and analyzed both the green urine and the normal urine using LC-MS. CONCLUSION We experienced a case of a patient with green discoloration of the urine after general anesthesia using propofol. Although LC-MS analysis showed 2 unique peaks in the green urine at 490 and 590 nm, obvious causes were not revealed.
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Affiliation(s)
- Keiko Fujii-Abe
- Tokyo Medical and Dental University, Graduate School, Anesthesiology and Clinical Physiology, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8503, Japan; Department of Dental Anesthesiology, School of Dental Medicine, Tsurumi University, 2-1-3 Tsurumi, Tsurumi-ku, Yokohama city, 230-8501, Japan.
| | - Hiroshi Kawahara
- Department of Dental Anesthesiology, School of Dental Medicine, Tsurumi University, 2-1-3 Tsurumi, Tsurumi-ku, Yokohama city, 230-8501, Japan
| | - Haruhisa Fukayama
- Tokyo Medical and Dental University, Graduate School, Anesthesiology and Clinical Physiology, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8503, Japan
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Rawal G, Yadav S. Green Urine Due to Propofol: A Case Report with Review of Literature. J Clin Diagn Res 2015; 9:OD03-4. [PMID: 26673613 PMCID: PMC4668454 DOI: 10.7860/jcdr/2015/15681.6706] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 09/03/2015] [Indexed: 11/24/2022]
Abstract
The change in the colour of urine is a known occurrence in an intensive care setting and is always a cause of concern to the clinicians who have to differentiate between benign and pathological causes. Herein, we present a case of 62-year-old postoperative lady, noticed to be passing green coloured urine believed to be due to intravenous Propofol administration for induction of general anaesthesia. The green colour of urine due to Propofol occurs when clearance of Propofol exceeds hepatic elimination, and extrahepatic elimination of Propofol occurs. This discolouration of urine is a rare (less than 1% cases) but a benign side effect of Propofol, which is non-nephrotoxic and gets reversed after discontinuation of the drug.
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Affiliation(s)
- Gautam Rawal
- Attending Consultant-Critical Care, Rockland Hospital, Qutab Institutional Area, New Delhi, India
| | - Sankalp Yadav
- General Duty Medical Officer-II, Chest ClinicMoti Nagar, North MCD, New Delhi, India
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Lyden PD, Rincon F, Staykov D, Lyden PD. Clinical Studies Targeting Stroke. Ther Hypothermia Temp Manag 2015; 5:4-8. [DOI: 10.1089/ther.2015.1501] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Patrick D. Lyden
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Fred Rincon
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Dimitre Staykov
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Patrick D. Lyden
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California
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