Continuous cardiovascular monitoring is a mainstay of safe anesthetic practice. When a precordial stethoscope is not practical, the esophageal stethoscope has proven useful and is presumed to be innocuous. Two cases in which the esophageal stethoscope directly contributed to intraoperative complications were reported. In procedures involving dissection of the neck, even when performed by experienced surgeons, the esophageal stethoscope can lead to mistakes in identification of anatomic structures.