Several people have queried the availability of articles in the medical
literature related to how close to surgery breastfed babies/children can be
breastfed without danger of aspiration of vomitus.

The September 1996 issue of PEDIATRICS contains a statement from the
Section on Anesthesiology, "Evaluation and preparation of pediatric
patietns undergoing anesthesia" Vol. 98, pp.502-8.

Included in this document are some references that relate more directly to
the breastfed child than the other references. Feel free to check them out
to see if they will help.  These references support discussion in the
section of the discussion entitled "What is 'NPO?'" and follows the
statement that "Recent studies have shown that the limited intake of a
clear liquid (a liquid that one can see print through, such as sugar water
or apple juice) up to 2 or 3 hours before anesthesia does not significantly
increase the volume int he stomach or alter the pH of the gastric contents
(both of which may increase the risk of aspiration pneumonitis). In
addition to not increasing the risk of aspiration, consumption of clear
liquids is better accepted by the fasting child."

Schreiner MS, et al: Ingestion of liquids compared with preoperative
fasting in pediatric outpatients. ANESTHESIOLOGY 1990; 72:593-97

Splinter WM, et al: The effect of preoperative apple juice on gastric
contents, thirst and hunger in children. CAN J ANAESTH 1989; 36:55-58

Splinter WM, et al: Clear fluids three hours before surgery do not affect
the gastric fluid contents of children. CAN J ANAESTH 1990; 37:498-501

Splinter WM, et al: Large volumes of apple juice preoperatively do not
affect gastric pH and volume in children. CAN J ANAESTH 1990; 37:36-39

See also: Litman RS, et al: Gastric volume and pH in infants fed clear
liquids and breast milk prior to surgery. PEDIATR ANESTHESIA 79:482-85,
1994 - this reference - not referred to in the Section statement - does
examine breastmilk directly and concludes that it is LESS SAFE than water,
owing to the somewhat longer gastric emptying time measured in the
breastfeeding babies than in those getting other "clear" fluids.  In spite
of this, women I know whose babies were exclusively breastfed have
continued to nurse right up to 2 hours before surgery and their babies have
not experienced difficulties. I wonder if some of this is related to the
comfort level of physicians who are (or are not!) familiar with
breastfeeding and how it calms the baby, as well as how well/completely it
is digested, and that the substance in question is non-irritating in lungs.

MDs out there.  Your comments, please?




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