The official website of the critically acclaimed Blue Man Group (http://www.blueman.com/about-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.
We present a case of an unanticipated difficult airway in a 40-year-old male scheduled for elective middle ear surgery. Intraoperative surgical findings were highly suspicious of ochronosis, which was later confirmed during outpatient work up. Recovery from anesthesia and surgery was uneventful.
Ochronosis is frequently observed in patients with alkaptonuria, which is inherited in an autosomal recessive manner. The disease leads to bluish-black tissue discoloration of connective and cartilaginous tissues, affected by chronic inflammation and degeneration. Patients suffering from Alkaptonuric ochronosis may present with airway management problems, and the anesthesiologist should become familiar with the widespread implications of the disease on perioperative management.