If this has been asked before, I apologize.  Couldn't find it in my Lactnet
files.  I had a long and fairly testy conversation with the head of
anesthesiology today; a mother called him to complain that the anes. gave her a
drug that shouldn't have been used, so he promptly called me to ream me out for
"scaring" mothers.  Short question #1:  Do you have any more information on
Propofol than what is in Medications and Mother's Milk Vol. 4?  (Used for IV
sedation anesthesia.)

Longer story:  Mother of a 7-day-old to surgery for removal of a kidney stent
(sp?), was very clear that she wanted anesthesia that would allow her to resume
breastfeeding ASAP after surgery.  I had offered to look up anything she or the
anes. would like if there were any question as to the effect on the baby.  (I
usually offer to do this because so many moms have been told to pump & dump for
some arbitrary long time that seems to have no basis.)  She was told before
surgery that she would be able to resume nursing within 4 hours.  After surgery
she was told to pump & dump for 8 hours.  She received Versed, Fentanyl, and
Propofol (250 mg).  The red book says "Propofol is known to be secreted into
breastmilk, although the levels are unreported.  This drug is extremely lipid
soluble and is likely to continuously enter breastmilk for several days after
surgery.  It would not be a suitable choice in a breastfeeding mother."  When I
read this to the mother when she called after surgery she was upset that she had
not been told this.  When the head of anesthesiology called to ream me out today
he was most definite that the information was incorrect, and Propofol was
"excreted the fastest of any of the neuro-hynotics" and I had no business
getting involved.

Short question(s) #2:  I understand the cautions with diazapam and BF because it
accumulates, but is there any concern with a one-time pre-op dose?  (The
cocktail of choice lately seems to be valium + reglan + zantac.)  And how about
the zantac as a one-time dose?

Seems to me that we could cut down on some of this stuff for a short procedure
on a mother of a one-week-old, but what do I know--I'm just the LC!  Thank you
for any info you may have.

Becky Krumwiede, RN, IBCLC, Appleton, WI
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