Tongue piercing and obstetric anesthesia: is there cause for concern?

The practice of oral tissue piercing, until recently, has been limited mainly to various native tribes in Africa. However, in recent years, body piercing (including oral tissue piercing), has become increasingly popular in the United States and Europe. We present a case of an obstetric patient who presented for emergency postpartum surgery with fixated tongue jewelry in situ, which resulted in trauma to the tongue and difficult airway management. The difficult airway management consisted of tongue bleeding at the time of laryngoscopy and tongue edema at extubation. We consider these two events to be near misses of "cannot intubate" and "cannot ventilate" situations, respectively. Because the popularity of body piercing is increasing in our society, it is reasonable to expect that the incidence of oral jewelry interference with airway management will also increase. Based on this experience, we advise laboring patients with oral jewelry to remove the hardware before receiving anesthesia for safety reasons.