A 22-year-old female (ASA 1) is scheduled for an elective diagnostic laparoscopy under general anesthesia. Her past history is unremarkable. She takes no medication and she has no history of allergy. On the day of surgery, the patient’s tongue is found to be pierced with a silver dumbbell-shaped piece of jewelry. This was not found by the preoperative clinic staff nor was it mentioned in the surgeon’s note. The jewelry is seen in the anterior one third of her tongue and is sticking out of the tongue by 1 cm. You request that she remove the tongue ring, but she is reluctant to do so as it has been put in only 3 weeks ago. You warn her of the potential dangers, but she refuses to remove the tongue ring. You attempt to find a colleague that would be willing to do the case with the ring in situ. However, all your colleagues are either busy or reluctant to do the case. This leaves you with two options:
Tell her that you would be happy to do the anesthetic if she removes the ring prior to surgery. If she refuses to remove the ring, you will cancel the case.
Do the case with the ring in situ.
KeywordsTongue ring General anesthesia Airway Laparoscopy Anesthesia risks
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