“Everything should be as simple as can be, but not simpler. " Albert Einstein The past decade has been marked by a trend from invasive to noninvasive intraoperative monitoring. As far as respiratory monitoring is concerned, initial experience with transcutaneous gas analysis laid the foundation for widespread clinical use of pulse oximetry and end-tidal gas analysis. It has been long recognized that echoÂ- cardiography might become an equally useful adjunct to cardiovascular monitoring. The fundamental purpose of cardiac monitoring is to warn the anesthesiologist of existing or impending cardiac abnormalities, so they can be corrected or prevented before the patient is harmed. Forces wi thin and ou tside of medicine are pressuring our specialty to improve cardiovascular monitoring. For instance, the average age of the population is increasing, resulting in more elderly patients presenting for major surgical procedures. At the same time, the medical-legal establishment stands ready to hold anesthesiologists accountable for almost any adverse outcome associated with anesthesia or surgery. ! In an effort to deal with this pressure, anesthesiologists have often resorted to invasive cardiovascular monitoring. However, invasive procedures are expensive, and even in the most experienced hands, they sometimes result in complications. In the past few years, with the development of modern computerized medical ultrasonics, anesthesiologists have recognized the usefulness of trans esophageal echocardiography (TEE) as a new monitoring technique. TEE is the most complex, sophisticated, and potent cardiovascular monitor ever introduced.
