Hypoxia caused by body piercing

I read with interest Dr Wise's letter (Anaesthesia 1999; 54: 1129) on hypoxia caused by body piercing. I pre-operatively visited a young woman scheduled for extraction of her four wisdom teeth. When I explained to her that all her jewellery, including a right nose stud, should be taken out before the anaesthetic, she claimed her nose stud, which was recently put in, would be very painful to take out and likely to be difficult to reinsert post anaesthesia. I therefore agreed that the stud should be kept in place and carefully taped in situ. This woman also suffered from a long-standing left nasal obstruction probably due to a significant left nasal septum deviation. In the operating theatre, a nasotracheal tube was passed easily through the right nostril using a fibreoptic scope. Surgical drapes were applied over the patient's face and surgery proceeded uneventfully. When I handed over to a senior colleague prior to starting the next case, I failed to draw his attention to the presence of the stud, assuming that the tape over it would make the stud's presence obvious. Following extubation of the patient, the tape was still present but the stud was no longer in the nose. There was no injury sustained by the patient. A nasal fibreoptic endoscopy and an airway X-ray proved to be negative. Thereafter, the stud was fortunately found lying underneath the operating table. The patient proceeded to make an otherwise uneventful recovery. This case begs a similar question to the one raised by Dr Wise; whether we should be anaesthetising patients with nose studs in situ.