Unanticipated Hospital Admission and Readmission

Case Synopsis

A 45-year-old woman, body mass index (BMI) 24, American Society of Anesthesiologists (ASA) physical status 2, underwent left eye orbitotomy for the correction of thyrotoxic exophthalmos under general anesthesia in a freestanding ambulatory surgical center. The patient tolerated the procedure well without anesthetic complications. However, the surgery was unexpectedly difficult and lasted more than 2 hours. The estimated blood loss (EBL) was about 50 mL. Postoperatively, the patient complained of severe pain in her left eye, which did not improve and worsened after multiple doses of intravenous fentanyl and hydromorphone. The surgical team was called and came to the postanesthesia care unit (PACU) to examine the patient. They found that the patient’s left orbit was swelling, and the intraocular pressure was elevated, likely due to an intraorbital hemorrhage. The patient was taken back to the operating room late in the afternoon for exploration of the orbit. A blood clot was evacuated from the orbit, but continued oozing persisted. The EBL was 300 mL for this procedure. The patient was transferred by ambulance to the hospital for angiography to determine the source of bleeding and further treatment. No active bleeding was identified, and the patient lost her vision in the operated eye. She was an inpatient for several days for observation and treatment. Her vision eventually recovered.