61-year-old man for Ivor-Lewis

Background

• 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.

Issues

• 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

Discussion

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

Plan

• Discuss with immunologist regarding allergy testing preoperatively