PURPOSE: As progress has been made in the acquisition of cardiac images with transoesophageal echocardiography, the technique has moved from the confines of the cardiology laboratory into the operating room, the intensive care unit, and the emergency department. This has afforded anaesthetists the opportunity to become familiar with, and develop expertise in its practice. The purpose of this article is to present a review of transoesophageal echocardiography with reference to anaesthetic practice. SOURCE: The principle source of material was a computerized MedlineTM search of the English language literature from 1986 to 1995. PRINCIPLE FINDINGS: After discussing the technique of probe insertion, and describing some of the standard images, transoesophageal echocardiography's clinical utility is critically assessed. Comparisons with available monitoring techniques are made with reference to ventricular function, valvular heart disease, pericardial, aortic and congenital heart disease, and the management of the multiple traumatized patient. Issues of certification and maintenance of competence are also discussed. CONCLUSION: Although the benefit of transoesophageal echocardiography is intuitive in many clinical situations, in others, it has not been shown to improve upon presently existing monitoring techniques. The need for adequate training and collaboration with cardiology colleagues is emphasized.