Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 08 18 1568 1568 EN Shohini Das Department of Anesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Center, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India. Shrutika Borikar Department of Anesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Center, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India. 2026 02 28 2026 04 08 Pulmonary complications during endoscopic retrograde cholangiopancreatography (ERCP) performed under general anesthesia are uncommon but may become life-threatening, particularly following prone positioning. We report a case of intraoperative pulmonary edema that presented as an abrupt rise in end-tidal carbon dioxide and reduced bilateral air entry shortly after proning for ERCP. Early recognition guided by capnography and clinical examination, followed by prompt ventilatory and pharmacological management, resulted in a favorable outcome. This case highlights the importance of vigilant respiratory monitoring and early intervention during prone endoscopic procedures, especially in patients with compromised cardiac function. https://aacc.tums.ac.ir/index.php/aacc/article/view/1568