Trans-oesophageal echocardiography (TOE): contra-indications, complications and safety of perioperative TOE.

Trans-oesophageal echocardiography (TOE) has become an almost universal intraoperative monitor and diagnostic tool. The use of TOE in most cardiac, aortic, major vascular and transplant operations is used to aid anaesthetic management as well as assist surgical decision-making. In addition to the perioperative environment it is increasingly being used in the Outpatient Department, Emergency Department and Intensive Care settings. In this review we consider the safety associated with the use of TOE, we review the suggested contra-indications and areas that we would consider to TOE to be a necessity. Two case reports at the beginning of the review highlight the need for vigilance and care when utilizing TOE.