Patients showing up with green hair?

If patients say they feel a bit green after surgery, there may be something literal to it.Multiple case reports address patients who ended up with green hair shortly after recovering from surgery. The culprit appears to be the commonly used propofol. The drug is known to be associated with rare occurrences of green discoloration of the urine. An example is a case report of a 54-year-old women who underwent general anesthesia with a cocktail of fentanyl, lidocaine and propofol and maintained with isoflurane and nitrous oxide.Within the first hour of the 2.5-hour long surgery, her urine color changed from yellow to green then resolved by the end of the surgery. Photos of her green urine have an uncanny resemblance to lime-flavoured Kool-Aid. How does this happen? The paper stated that “the 4-sulfate and 1- or 4-glucuronide conjugates of 2,6-diisopropyl-1,4-quinol are renally excreted and may rarely result in green urine discoloration, as seen in this case.” The greening of urine has been reported mostly after prolonged infusions.Another case report and review explained that green urine due to propofol happens “when the clearance of propofol exceeds hepatic elimination.”The drug is also associated with other shades of colourful urine such as pink, white, red and brown.But affecting hair colour is less common but possible side-effect. In a case in Anesthesiology, a 60-year-old man who entered the hospital with silver-white hair was found to have a greenish-blue tint in his hair while in recovery. He had undergone spinal anesthetic for a total hip replacement.The patient said he had experienced a similar hair discoloration after a previous general anesthetic. Propofol, fentanyl and cefazolin were the anesthetic agents used in both instances. For him, the greenish hue lasted up to two months, and the color change was most pronounced around the temples, but not his scalp.The authors of this case report stated that “Although the mechanism for hair discoloration after propofol administration is unknown, it may involve phenolic metabolites excreted into hair-coating sebum, which is constantly produced by the sebaceous glands.”Green hair was also reported back in 1989 where it happened to a 42-year old woman who presented for dilation and curettage. Anesthesia was achieved with propofol after fentanyl, and maintained with nitrous oxide.In that case, the patient noticed her hair was turning green 48 hours after the surgery. The discolouration affected both head and pubic hair. This was “not of a lawn green, but a brassy colour with a slight green tint covering the entire length of the hair shafts.” Her hair started off as silvery-blonde.Copper levels were checked in some reports, but not found to be a culprit. While the exact mechanism for green hair associated with anesthesia remain unknown, it is considered benign.

Patients showing up with green hair?

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