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Background There are several recent reports that left upper lobe lung resection is a risk factor for the development of postoperative thromboembolism. Although administering epidural analgesia is common in thoracic surgery, anesthesiologists should be alert when administering epidural analgesia to a patient undergoing left upper lobe resection, considering the increased risk of postoperative thromboembolism and the potential need for anticoagulation or fibrinolytic therapy in the immediate postoperative period. Case presentation A seventy-one-year-old female with a metastatic lung lesion developed a cerebral infarction approximately 30 hours after video-assisted thoracoscopic left upper lobectomy. Cerebral intravascular therapy was indicated and the epidural catheter was removed immediately to avoid formation of an epidural hematoma. Approximately four hours after onset, reperfusion was successfully established by aspiration of endovascular thrombi. She recovered with mild residual paralysis of the left upper extremity and was transferred to a rehabilitation facility. Conclusions We present a patient with a cerebral infarction after left upper lobe resection. Left upper lobe resection is associated with an increased risk of postoperative thromboembolism. Although the exact mechanism of thrombosis after left upper lobe resection is unclear, a judicious decision should be made regarding epidural catheter placement for postoperative analgesia.

Background There are several recent reports that left upper lobe lung resection is a risk factor for the development of postoperative thromboembolism. Although administering epidural analgesia is common in thoracic surgery, anesthesiologists should be alert when administering epidural analgesia to a patient undergoing left upper lobectomy, considering the increased risk of postoperative thromboembolism and the potential need for anticoagulation or fibrinolytic therapy in the immediate postoperative period. Case presentation A seventy-one-year-old female with a metastatic lung lesion developed a cerebral infarction approximately 30 hours after video-assisted thoracoscopic left upper lobectomy. Cerebral intravascular therapy was indicated and the epidural catheter was removed immediately to avoid formation of an epidural hematoma. Approximately four hours after onset, reperfusion was successfully established by aspiration of endovascular thrombi. She recovered with mild residual paralysis of the left upper extremity and was transferred to a rehabilitation facility. Conclusions We present a patient with a cerebral infarction after left upper lobectomy. Left upper lobectomy is associated with an increased risk of postoperative thromboembolism. Although the exact mechanism of thrombosis after left upper lobectomy is unclear, a judicious decision should be made regarding epidural catheter placement for postoperative analgesia.

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Background: Procedural sedation is increasingly used for elderly patients, but there is no established ideal method for elderly patients who are prone to respiratory and circulatory depression. This study aims to investigate the association of respiratory complications and the combination of ketamine-propofol versus fentanyl-propofol in elderly patients undergoing prostate biopsy requiring deep sedation.Methods: This was a single-center, retrospective, observational study conducted from April 2020 to March 2021. We included male patients aged 65 years and older scheduled for prostate biopsy under procedural sedation. Ketamine-propofol and fentanyl-propofol were administered at the discretion of the anesthesiologist. The primary outcome was the need for assisted ventilation. The secondary outcome was the duration of oxygen saturation (SpO 2 ) below 90%.Results: We enrolled 120 patients over 65 years, and 92 patients were included in the final analysis. The anesthesiologist administered an initial dose of ketamine and propofol of 1:1 to 1:4 of 1.0 mg kg -1 (interquartile range: 0.98 to 1.17) or administered an initial dose of fentanyl of 0.05 to 0.1 mg and a targetcontrolled infusion of propofol of 2.8 μg ml -1 (interquartile range: 2.0 to 3.0) followed by additional doses at the discretion of the anesthesiologist. Ketamine-propofol was associated with a reduced need for assisted ventilation and a shorter duration of SpO2 below 90% than propofol-fentanyl (95.7% vs. 4.3%, P < 0.05; 0.64 minutes vs. 0.17 minutes, P = 0.26).Conclusions: Ketamine-propofol is associated with a significantly reduced need for assisted ventilation compared to propofol-fentanyl during procedural sedation and analgesia for procedures requiring deep sedation for the elderly.