Blue Man… at Stanford?

The official website of the critically acclaimed Blue Man Group describes the group’s show as “visually stunning”, “wildly inventive,” and “hysterically funny.” This was certainly not the experience of the Stanford anesthesia team, which was left flabbergasted when managing the airway of one of the apparent Blue Man group’s impersonators.

Presented by  Tatyana Travkina, M.D. and  Ahmed Zaafran, M.D., Stanford University Medical Center.

We present a case of a 40 year old male patient who had presented to the ENT clinic with a left ear canal mass and ongoing conductive hearing loss. He was scheduled for left tympanomastoidectomy, excision of left ear canal tumor and microdissection. The planned surgical procedure was scheduled for 3 hours in the ambulatory surgical center.

The patient’s past medical history was significant for obesity (BMI 34 kg/m²), OSA treated by CPAP, and hayfever.  The patient had no drug allergies and patient was not taking any medications on daily basis. Patient was a native of Guam but was raised in the United States. The patient’s family history was non-contributory.

Physical exam revealed an obese male with short, thick neck, decreased oral entry (small mouth), big tongue, Mallampati III grade, normal mandibular protrusion, and thyromental distance of 5 cm. The rest of the airway exam was normal, and physical exam was otherwise unremarkable.

Preoperative laboratory tests were within normal range. The patient had normal exercise tolerance. Preoperative vital signs were: BP 122/82 mm Hg, Pulse 85/min, respiratory rate 16/min, SpO₂ 98% on room air. On the day of surgery, the patient had been NPO for over 8 hours.

Although the patient’s airway exam was predictive of difficult mask ventilation and difficult direct laryngoscopy (DL), we felt that awake approach to intubation was not warranted, and opted for an alternative ventilation and intubation strategy using a LMA Fastrach after induction of anesthesia.

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