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Tattooing and various piercing: anaesthetic considerations

Mercier, Frédéric J; Bonnet, Marie-Pierre

Current Opinion in Anesthesiology: June 2009 - Volume 22 - Issue 3 - p 436–441
doi: 10.1097/ACO.0b013e32832a4125
Anesthesia and medical disease: Edited by François Clergue

Purpose of review Body art is increasing since the 1990s. Anaesthesiologists would be more and more confronted to patient with tattooing or piercing, or both. This review discusses the anaesthetic potential risks and complications observed with tattooing and piercing, their management and prevention.

Recent findings Airway management during anaesthesia is of particular interest with oral jewellery. Patients often refuse to remove their piercing for fear of tract closure. There are no serious complications reported after epidural puncture through a tattoo, although any long-term consequence cannot be discarded yet. Even theoretical concerns are more and more debated.

Summary Oral and nasal piercing is of particular concern because of the risks of swallowing and aspiration. Consequently, patients should be advised to remove piercing before anaesthesia. Emergency situations are especially risky and anaesthesiologists should be aware of the piercing removal techniques. In case of piercing loss, radiographies and fiberoptic endoscopy of the upper airways and digestive tracts should be performed to eliminate aspiration or swallowing of the foreign body. Epidurals should not be denied to parturients with lumbar tattooing. However, it seems still prudent to avoid direct tattoo puncture or when unavoidable, to nick the skin prior to inserting the needle through the tattoo.

Département d'Anesthésie Réanimation, Groupe Hospitalier Paris Sud, Hôpital Antoine Béclère, Assistance Publique - Hôpitaux de Paris, Université Paris-Sud, Clamart, France

Correspondence to Frédéric J. Mercier, MD, Ph.D., Département d'Anesthésie-Réanimation Chirurgicale, Hôpital Antoine Béclère, 157, rue de la Porte de Trivaux, 92141 CLAMART, Cedex, France Tel: +33 1 45 37 42 73; fax: +33 1 45 37 49 85; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.