To      : Becky Krumwiede:
Re      : Propofol

        I'm sorry you were berated by the anesthiologist.  Propofol is a
unique preanesthetic agent that rapidly enters the brain, produces
sedation,  and then due to redistribution rapidly clears the brain.
However,  this product has one of the largest volumes of distribution I
have seen,  60 Liters/Kg.  This means that although mom may wake up just
fine,  her adipose tissue is stuffed with this compound which will slowly
be cleared over the next few days. In adults, fifty percent of the product
is cleared via glucoronide conjugation(which is not present in infants).
The terminal half-life in adults is 1-3 days,  reflecting the extensive
tissue uptake.  In a breastfeeding mom, her breast milk would be
continuously perfused with low levels of propofol during this time and that
is why I think it less than perfect for this population.  I don't know with
certainty that it would sedate the breastfeeding infant,  but it could.  I
believe that Versed(Midazolam) is a better choice as preanesthetic for
breastfeeding moms.  It has a much shorter half-life and Volume of
Distribution.

As per the one-time use of Valium+Zantac+Reglan,  I doubt these would
seriously effect an infant to any measurable degree following only one
dose.


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It seems that one consistent theme that occurs almost daily is the issue of
anesthetic gases, and other agents used during surgery and delivery.  It
would seem that we as a group should develop a Task Force to study this
issue.  Maybe get some Chairmen of Anesthesiology Departments together
along with BF advocates  and come up with a "Preferred Anesthesia for
Breastfeeding Mothers".  Then all of us could then say to our respective
hospitals,  this is a Lactation Task Force approved protocol.  If you don't
use it,  we'll find other anesthesiologists who will.  Remember, we're
consumers now !!!!!

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Tom Hale