Buckling of transesophageal echocardiography probe: a pitfall at insertion in an anesthetized patient

Buckling of the transesophageal echocardiography probe was encountered in 6 of 23 patients (26.1%), although no complication occurred. When buckling occurred, acquisition of images and manipulation of the probe became difficult, resistance was felt when withdrawal of the probe was attempted, and the probe was fixed in the extreme ante- or dorsiflexion. In this situation, the probe was carefully advanced into the stomach, in which the buckled probe was unfolded, and then withdrawn to the esophagus. Buckling of the probe tip is not uncommon at insertion of the probe, especially when using a flaccid probe in an anesthetized patient. A TEE operator should be aware of the possibility of buckling. Unusual resistance associated with buldging of the submandibular region is a sign of a folded-up probe tip. Use of laryngoscopy is recommended in order to avoid inserting the buckled probe into the esophagus.