BACKGROUND In recent years, it has been recognized that transesophageal echocardiography (TEE) is of great value in resuscitation of cardiac arrest. However, its safety has rarely been reported. CASE SUMMARY We present a 59-year-old male patient scheduled to undergo cardiac surgery for rheumatic heart disease. Upper gastrointestinal bleeding from a Mallory-Weiss tear appeared following cardiopulmonary resuscitation, TEE, and percutaneous cardiopulmonary bypass resuscitation when he suffered from aesthesia-related cardiac arrest. Gastrointestinal injury was diagnosed promptly and treated effectively. However, the exact etiology of gastrointestinal injury was unclear; the interaction of closed-chest cardiac massage and the application of TEE may be involved as a most possible mechanism of injury. CONCLUSION Serious complications should be considered when TEE is used in patients with special pathophysiological conditions.

Background: Airway management and anesthesia during endolaryngotracheal surgery in patients with obstructive airway diseases pose a major challenge for anesthesiologists, especially in pediatric patients.Children with obstructive airway disease often have a potentially difficult airway. Adequate airway assessment and preparation before anesthesia is essential. In the formulation of the entire anesthesia strategy, the choice of ventilation mode is the most critical. Superimposed high-frequency jet ventilation (SHFJV) is an enormous step forward in the progress of difficult surgery of the larynx and trachea in neonates, infants and children. However, due to objective factors, it has not been extensively applied worldwide.Case Description: In this article, our airway management strategy and clinical anesthesia experience is presented in a precisely designed, non-invasive and "tubeless" supraglottic SHFJV technique. This technique was used during a successful endolaryngotracheal surgery in a 3-year-old child with congenital subglottic stenosis under total intravenous anesthesia (TIVA) with propofol and remifentanil. Ultimately, the entire procedure and anesthesia were successful, and the child received effective treatment.Conclusions: By summarizing and sharing our airway management strategy and clinical anesthesia experience in this case, anesthesiologists may have a clearer understanding of the challenges in this type of surgery. This case may add a valuable reference for the extensive application of SHFJV in endolaryngotracheal surgery.

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