Case 69: Bleeding After Oral Surgery
A 55-year-old man (74 kg, 5 ft 11 in.) is admitted with a painful ulcerative lesion in the left retromolar area. The lesion is 1.5 cm. A biopsy of the lesion under local anesthesia 2 days ago has revealed a carcinoma in situ. He is scheduled today for a wide excision with periosteal stripping of the mandible. He has a long history of depression for which he takes sertraline (a selective serotonin reuptake inhibitor (SSRI)) 100 mg daily. Since he has had a lot of pain, he has been taking naproxen (a nonsteroidal anti-inflammatory drug) 500 mg twice daily. He also smokes about 20 cigarettes and drinks 5 units of alcohol/day. He denies other medical concerns and he has no allergies. Physical exam is none contributory. His EKG and laboratory results are all normal including the coagulation results. He is very nervous and you give him 6 mg of midazolam prior to coming to the operating room. You anesthetize him in a routine manner with fentanyl, propofol, and rocuronium. His airway is secured with an oral endotracheal tube. The anesthesia maintenance is with N2O in 30% oxygen and desflurane. At the end of surgery, the wound is closed and hemostasis is achieved. The patient’s MAP at the time of closing was 10% below the starting MAP. The patient is taken to the recovery room awake, pain free, and with stable vital signs. An hour later you are called stat to the recovery room.
KeywordsOral surgery Hematoma Airway obstruction