Before emergence from anesthesia, the oropharynx was suctioned, and the patient was extubated while sedated, spontaneously breathing, and in an upright position. During extubation, the patient coughed and subsequently developed signs and symptoms of severe bronchospasm: wheezing during a prolonged phase of forced exhalation as well as the use of accessory muscles. There was no evidence of stridor during inspiration, as would be consistent with laryngospasm. No gastric secretions were noted in her oropharynx on inspection nor with subsequent suctioning. Despite adequate oxygenation, ventilation with bag-mask remained difficult even after insertion of an oropharyngeal airway and a nasal trumpet. After about 30 min, frothy, pink sputum was noted to be coming from the patient’s mouth. Furosemide was administered for possible pulmonary edema. A 12-lead ECG showed sinus rhythm and no evidence of acute ischemia or infarction. A chest radiograph taken immediately after admission to the post-anesthesia care unit (PACU) showed diffuse bilateral opacities despite net negative intraoperative fluid balance (Fig 1C). Transthoracic echocardiogram demonstrated normal anatomy and function with an estimated right ventricular systolic pressure of 34 mm Hg (assuming right atrial pressure of 10 mm Hg).