The Lithotriptor Patient

  • Cathy Wall Thomas


An 8-year-old white boy was admitted with a history of recurrent bouts of urinary tract infections and right flank pain. There was a strong family history of renal calculi on his father’s side and the boy himself had undergone extracorporeal shock-wave lithotripsy (ESWL) six months earlier. His mother reported that on that occasion, when she first saw him in the recovery room, he had a tube in his mouth and was connected to a breathing machine. The doctor told her that the boy had “lung problems.” Although he had been scheduled for the procedure as an outpatient, he remained in the hospital four days. He has had no further respiratory difficulties. Anesthesia at the time of cystoscopy was uneventful. The patient is currently taking chlorothiazide.

Physical examination: weight 33 kg; height 54″; blood pressure 100/70 mmHg; pulse 86/min and regular; chest clear. All chemical analyses were within normal limits.

The previous anesthetic record revealed that after induction with atropine 0.3 mg, thiopental sodium 225 mg, and succinylcholine 40 mg, the trachea was intubated and anesthesia was continued with halothane. After 55 minutes, the anesthesiologist noted frequent ectopic beats with periods of bigeminy and tachycardia of 150 bpm. Initial therapy with lidocaine and carotid sinus massage was ineffective. Edrophonium 3 mg was given intravenously twice and isoflurane was substituted for halothane. The heart rate decreased to 130 bpm and normal sinus rhythm returned.

In the recovery room, signs and symptoms were consistent with pulmonary edema. Furosemide 40 mg was given and respiration supported for 40 minutes. Thereafter, the trachea was extubated and the respiratory changes subsided over 24 hours.


Regional Anesthesia Renal Calculus Urinary Calculus Primary Hyperoxaluria Sand Mass 
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© Birkhäuser Boston Inc. 1989

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  • Cathy Wall Thomas

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