Pulmonary oedema after lithotripsy in a patient with hypertrophic subaortic stenosis.

Pulmonary oedema in a patient with hypertrophic subaortic stenosis undergoing extracorporeal shock wave lithotripsy is described. This event occurred upon emergence from the bath. It is suggested that pulmonary oedema followed emergence because of a reduction in central venous pressures and a decrease in preload which led to transient dynamic obstruction. Treatment with beta adrenergic blockade reduced outflow tract obstruction. Anaesthetists should be aware of the haemodynamic consequences of immersion and emersion with extracorporeal shock wave lithotripsy.