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EDITOR: The use of transoesophageal echocardiography (TOE) is common in congenital heart repairs and considered relatively safe [1]. We report severe desaturation and decrease in ETCO2 after TOE probe insertion. A 3-yr-old, 10-kg child, was premedicated with propranolol 5 mg, morphine 1 mg and glycopyrrolate 0.1 mg. In the operating room, SPO2 on room air was 76–80%. Anaesthesia was induced with O2, sevoflurane and fentanyl 40µg. Pancuronium 1.5 mg was given to facilitate oral intubation with a 5 mm endotracheal (ET) tube. The ET tube was taped at the 12.5 cm mark and its position confirmed by auscultation and advancing it to the carina and backing-out by 1 cm, followed by auscultation during flexion and extension of the neck. Mechanical ventilation was started in volume-controlled mode with O2 and isoflurane (0–1.5%) at a respiratory rate of 20 min 1 and tidal volume of 100 mL. The peak …