In this chapter, about 15 basic steps to perform a transesophageal echocardiography (TEE) with a focus on patient safety and comfort. In patients with a strong gag reflex, topical anesthesia improves patient comfort and eases probe insertion, and should be used unless contraindicated. Multiple techniques can be used to numb the oropharynx, using formulations of benzocaine; a mixture of benzocaine, aminobenzoate, and tetracaine (Cetacaine); or viscous lidocaine. Moderate sedation is typically used for most awake and stable patients; however, the degree of sedation that is safe depends on the individual.