Oesphagectomy, multiple allergies

61-year-old man for Ivor-Lewis


  • Oesophageal Cancer – Weight loss 20kg. Dysphagia, NGT in situ. Albumin=35, NACRT – ceased 1 month ago.
  • IHD – PCI in 2015. Normal stress imaging
  • Chronic pain – lumbar spine degenerative disease.


  • Multiple drug allergies reported including cephalosporins, and Local Anaesthetics.
  • Previous facet joint injections – one episode of infection with epidural abscess
  • Reports blistering and rash due to Benzocaine – uncertain if this was a localised reaction at the same time as the infection occurred
  • Additionally, a query allergy to lignocaine – documented in 2017, uncertain reaction
  • No history of anaphylaxis
  • No formal allergy testing


Conduct of anaesthesia

  • Ropivacaine likely the safest choice of local anaesthetic agent
  • Consensus that it would be difficult to perform an Ivor-Lewis without use of LA
  • Unusual to be allergic to 2 different classes of LA

Allergy Testing

  • It would be prudent to discuss with immunologist regarding possibility of performing preoperatively
  • Anaesthesia referrals usually wait 6 weeks, but this is in the event of a recent anaphylaxis
  • May be possible to have expedited intra-dermal testing for this patient
  • Definitive answer on antibiotic allergy would also be of benefit preoperatively


  • Discuss with immunologist regarding allergy testing preoperatively