To the Editor:—
We report a potential choking hazard with medical equipment in a 3-yr-old boy scheduled for diagnostic bronchoscopy. The backshell of a transparent facemask was swiped with a scented pen (T 5000 Mask-Ease pens, Trident Medical International, Indianapolis, IN) to facilitate the acceptance of the mask by the child. Inhalational induction was uneventfully performed with sevoflurane in oxygen/nitrous oxide.
During mask ventilation, a floating foreign body was observed by the attending staff anesthesiologist within the transparent facemask (Laerdal Infant Mask, Laerdal Medical, Stavanger, Norway), although it was undetectable for the ventilating anesthesiologist (fig. 1, top).
Mask ventilation was interrupted for a short time for inspection of the backshell of the mask, from which the foreign body was removed (fig. 1, middle). Further inspection showed it to be a broken tip from the Mask-Ease pen (fig. 1, bottom). Two additional cases of broken tips had previously occurred in our department but the tip had been detected before the facemask was used.
The choking potential of foreign bodies in children has not only been reported in connection with common foods and toys, but also with medical equipment such as syringe caps, the caps of inflatable face masks, and nasal cannulas. 1–3To our knowledge, there has been no publication until now about the choking hazard when using scented pens. The application of scented substances, such as Cherry or Bubble-gum, on the backshell of the facemask is an upcoming facility to make inhalational induction or preoxygenation in children more comfortable. However, as demonstrated in our case, the use of such pens carries the risk of accidentally placing a foreign body in the airway equipment and thus represents a potential choking hazard to the patient.