Anesthetic Implications of the New Guidelines for Button Battery Ingestion in Children

Ingestion of button batteries can result in a catastrophic, lethal injury if diagnosis and management is delayed. In the US, the National Capital Poison Center has established a guideline ( that helps triage patients who present and provides treatment advice based on cadaveric and animal studies. This includes expedited removal and pre-operative use of weak acids, such as honey or sucralfate, to neutralise the alkaline environment and prevent mucosal injury. The temporising measure of using honey and sucralfate may increase the risk of pulmonary aspiration at induction, but this risk is far outweighed by the benefit of preventing mucosal injury and its catastrophic consequences, such as oesophageal perforation and aorto-oesophageal fistula. This review provides a good reminder of the need to establish clear treatment protocols for this potentially fatal presentation.

Reviewed by Dr Scott Ma