Unusual adverse effect of dexmedetomidine and its management

Intraoperative dexmedetomidine-induced polyuria from a loading dose: a case report

With extensive perioperative use of dexmedetomidine, there has been rising concern about its side effects, which are most commonly bradycardia and hypotension. However, increased urine output or diuresis is not well recognized with perioperative use of dexmedetomidine. We report a case of intraoperative polyuria induced by dexmedetomidine. The unusual feature of this case is that only a loading dose of dexmedetomidine was administered, but there was a long-lasting and large effect of diuresis. The findings from our case suggest that clinicians should be alert to the risk of diuresis when using dexmedetomidine.

Perioperative Diabetes Insipidus Caused by Anesthetic Medications: A Review of the Literature

Diabetes insipidus (DI) is an uncommon perioperative complication that can occur secondary to medications or surgical manipulation and can cause significant hypovolemia and electrolyte abnormalities. We reviewed and evaluated the current literature and identified 24 cases of DI related to medications commonly used in anesthesia such as propofol, dexmedetomidine, sevoflurane, ketamine, and opioids. This review summarizes the case reports and frequency of DI with each medication and presents possible pathophysiology. Medication-induced DI should be included in the differential diagnosis when intraoperative polyuria is identified. Early identification, removal of the agent, and treatment of intraoperative DI are critical to minimize complications.