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Correspondence

Tongue piercing in an eclamptic patient

Nowicki, R. W. A.; Bull, P. T.

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European Journal of Anaesthesiology (EJA): November 2002 - Volume 19 - Issue 11 - p 844-845
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EDITOR:

Several reports illustrating the dangers of anaesthesia and the increasingly popular fashion for tongue piercing have been described recently [1]. It is clear that these devices can work loose in the unconscious patient and enter either the alimentary or respiratory tract. We describe a recent case of such a problem that occurred in our practice.

A 15-yr-old primiparous female, 30 weeks' pregnant, suffered an eclamptic seizure in the maternity ward. She had been admitted for observation and bed rest on the previous day with intrauterine growth retardation, a raised urate concentration and brisk neurological reflexes. The seizure was initially managed with diazepam, midazolam intravenously (i.v.) and an infusion of magnesium sulphate. She was then transferred to the operating room. Although the seizure had now ceased, the patient had a reduced level of consciousness and was unco-operative. After application of full monitoring, a standard general anaesthetic technique was employed and a live child was delivered by emergency Caesarean section. Upon recovery the patient was transferred to the intensive-care unit, underwent a brain computed tomographic (CT) scan (normal examination) and subsequently made an uneventful recovery. The chest radiograph is shown in Figure 1. One half of a barbell-shaped tongue stud was shown to be below the diaphragm in the stomach. This had presumably been swallowed during the seizure, as laryngoscopy had been unremarkable. It was allowed to pass through the gut without incident.

Figure 1
Figure 1

Elective general anaesthesia in the presence of such a device would seem at best to be unwise and our normal practice is to ask the patient to remove it. The patient is often concerned that replacing it will prove difficult. However, one solution is to pass an epidural catheter through the hole and tie it in a large loop allowing the piercing to be removed and replaced easily [2,3]. If this is met with refusal, then the risks need to be explained to the patient and full documentation made in the medical notes. Requesting the removal of these devices in patients at risk of eclampsia or convulsions from any cause is an obvious, but almost certainly unpopular suggestion. Improved documentation on admission of the elective patient may go some way to forewarning the anaesthetist of similar problems in the future. With the increasing use of these studs, it is now important to check for their presence routinely, especially in emergencies such as this where there has been a reduced level of consciousness and seizures may have caused displacement.

R. W. A. Nowicki

Queen's Medical Centre; Nottingham, UK

P. T. Bull

Kings Mill Centre for Healthcare Services; Sutton-in-Ashfield, UK

References

1. Wise H. Hypoxia caused by body piercing. Anaesthesia 1999; 54: 1129.
2. Brown DC. Anaesthetic considerations of a patient with a tongue piercing, and a safe solution. Anesthesiology 2000; 93: 307-308.
3. Thomas DI. Tongue piercing. Anaesthesia 2000; 55: 729-730.
© 2002 European Academy of Anaesthesiology