Anesthesia and Breastfeeding

I get a lot of questions from my friends about receiving anesthesia while breastfeeding.  As more moms are breastfeeding, I think it’s an important question to tackle for the baby’s safety.  I’ve included references and summarized key points below.  If you have any questions, please do not hesitate to ask your anesthesiologist or physician who will be taking care of you.

 

5FF01
From Anesthesiology, October 2017.

Breastfeeding after Anesthesia: A Review for Anesthesia Providers Regarding the Transfer of Medications into Breast Milk.  Transl Perioper Pain Med. 2015; 1(2): 1–7.

ABM Clinical Protocol #15: Analgesia and Anesthesia for the Breastfeeding Mother, Revised 2017.  BREASTFEEDING MEDICINE Volume 12, Number 9, 2017.

KellyMom: breastfeeding and surgery resources

Key Points:

  • Intrathecal and epidural anesthesia and opioids are ok for breastfeeding mothers.
  • Acetaminophen, ibuprofen, and ketorolac are ok because they have relatively short half-lives.
  • Celecoxib: ok.
  • Naproxen: ok.
  • Propofol is ok.  Proceed with breastfeeding when mom is awake after anesthesia.
  • Midazolam (sedation dose) is ok.  Proceed with breastfeeding when mom is awake after anesthesia.
  • Fentanyl is short-acting enough.  Proceed with breastfeeding when mom is awake after anesthesia.
  • Avoid meperidine in the post-operative unit – its metabolites have long half-lives.
  • Hydromorphone has a long half-life (10hours).  Best to avoid this medication or pump and dump.
  • Morphine: low dose is ok.  Caution if using morphine PCA.
  • Hydrocodone: dosage should be <30mg/day in breastfeeding moms.
  • Oxycodone: dosage should be <30mg/day in breastfeeding moms or not used at all.
  • Tramadol: ok. But FDA not recommend for breastfeeding moms (USA).

Things to Consider

  • Try to have your case booked as early in the morning to decrease the amount of time for fasting.
  • Pump a stash of breast milk ahead of surgery for 1 day of feeds just in case.  You can always use this expressed milk later.
  • Breastfeed or express milk just before the start of the procedure.
  • Have an adult supervise you post-operatively as well as the baby in case there are signs of medication transferred to the baby.
  • Consider anesthetic techniques (local anesthesia, regional anesthesia, non-narcotics, etc.) to minimize opioid consumption.

 

 

Advertisements

The comparison of the effects of dexmedetomidine, fentanyl and esmolol on prevention of hemodynamic response to intubation

A study out of Turkey…

Curious to see how this works in our ASA 3 and 4 CABG cases.

The comparison of the effects of dexmedetomidine, fentanyl and esmolol on prevention of hemodynamic response to intubation.
Rev. Bras. Anestesiol. vol.64 no.5 Campinas Sept./Oct. 2014

Blunting hemodynamic response to tracheal intubation #anesthesia

2% Lidocaine HCl preparation, pre-filled AbboJ...
Image via Wikipedia

https://secure.muhealth.org/~ed/students/articles/AnesthAnalg_72_p0482.pdf

This is an older study done that looked at placebo, lidocaine, fentanyl, and esmolol to blunt the effects of tracheal intubation/DL that typically occurs with it.  They looked at MAP/SBP and HR.  From their data, it appears that esmolol is the winner.  However, the doses of medication were not titrated to body weight.  It seems that everyone got the same dose.  Also, looks like everyone received pancuronium, a nice cardioaccelerator.  But, for what it’s worth, I can see using esmolol on pt’s who need perfect HR/BP control and no CHF.