Surely infants are at much higher risk from transplacental exposure during surgery than they are from exposure via breastmilk *after* the mother is no longer anaesthetised ...
who is teaching these guys to *think*?
Nina Berry
Australia
On 24/09/2011, at 3:04 AM, Laurie Wheeler wrote:
> Here is something we dealt with recently. 4 hrs is not ideal but better than 24 hrs. I have a little more info, stay tuned to lactnet.
>
> Hi xxx, Please pass on to your staff the info below that moms can breastfeed after 4 hrs (instead of waiting 24 hrs). Our pediatricians are ok with breastfeeding at 4 hrs. If you have any other meds you are concerned about, please email me and we'll get the info on those.
> Laurie Wheeler
> Breastfeeding Center
>
> ________________________________
>
> Below are the meds that Dr. xxx (anesthesia dr) told me are mainly used with the OB patients for surgery. I've looked them up in the most recent Medications and Mother's Milk book, and checked with the Infant Risk Center at Texas Tech University School of Medicine, a center which studies and provided info on meds and breastfeeding.
> I've included the info on them.
>
> propofol (diprivan) -- "particularly popular in various pediatric procedures." "the anesthesia is short, 3 - 10 minutes." "only very low concentrations have been found in breastmilk." "from the data it is apparent that only minimal amounts of propofol are transferred to human milk." "Propofol is rapidly cleared from the neonatal circulation."
>
> versed (midazolam) -- "the amount transferred to an infant via early milk is minimal." "...so rapidly redistributed to other tissues from the plasma compartment, milk levels will invariably be exceedingly low." Breastfeeding may be re-started after 4 hrs. Use caution with infants who have a history of apnea.
>
> fentanyl (sublimaze) -- "half-life is exceedingly short" "the concentration in milk was exceedingly low, generally below the level of detection." "It is apparent that fentanyl transfer to milk under most clinical conditions is poor and is probably clinically unimportant." "the authors conclude that with these small concentrations and fentanyl's low oral bioavailability, IV fentanyl analgesia may be used safely in breastfeeding women." Use caution with infants who have a history of apnea.
>
> succinylcholine (anectine) -- "ultrashort duration, clinical duration 5 - 8 minutes, half-life < 1 min"
>
> All of these drugs are rated L2 for lactation use: "Drug which has been studied in a limited number of breastfeeding women without an increase in adverse effects in the infant. And/or, the evidence of a demonstrated risk which is likely to follow use of this medication in a breastfeeding woman is remote."
>
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