Transoesophageal echocardiography (TOE) is regarded as a safe procedure and is widely practised by doctors with variable training. However, TOE often involves the use of intravenous sedation. Cardiorespiratory depression is well recognised during gastroscopy, accounting for up to two thirds of deaths.1 2 Information on the safety of sedation for TOE is more limited. There has been one large study involving 15 European centres and 10 419 TOE examinations.3 TOE was associated with acceptable low risk with a serious complication rate of 0.18% and mortality of < 0.01%. However, only one centre used routine intravenous sedation.

A Working Party report “Guidelines for sedation by non-anaesthetists” was published in 1993 by the Royal College of Surgeons of England to promote the safe practice of sedation across all specialties.4 In a survey …