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
- 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