title: Tattooing and various piercing: anaesthetic considerations.
abstract: OBJECTIVE
  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.
  
  
  RESULTS
  Airway management during anaesthesia is of particular interest with oral jewelry. 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Département d'Anesthésie Réanimation Chirurgicale, Hospitalier Paris Sud, Hôpital Antoine Béclère, 157, rue de la Porte de Trivaux, CLAMART, Cedex 92141, France. frederic.mercier@abc.aphp.fr
authors.forename: Frédéric J
authors.initials: FJ
authors.lastname: Mercier
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Bonnet
mesh_terms: D000758:Anesthesia / Q000009:adverse effects*; D000773:Anesthesia, Obstetrical; D046288:Body Piercing / Q000009:adverse effects*; D005260:Female; D006801:Humans; D009055:Mouth; D009666:Nose; D011247:Pregnancy; D013653:Tattooing / Q000009:adverse effects*