We now rarely give anything like this prior to surgery unless we're going to
do a fiberoptic intubation or it's an ENT procedure and the surgeon requests it.

My quick explanation, hopefully slightly clearer than mud:  Basically, at
the end of a case, if we've used a muscle relaxant (we do in most general
anesthetics when patients are intubated), we have to "reverse" the muscle
relaxant by giving an acetylcholinesterase inhibitor.  This increases the
amount of acetylcholine available at any neuro-muscular junction and should
allow voluntary muscle movement again.  But since a flood of acetylcholine
at the vagus nerve could be catastrophic (patients can get extremely
bradycardic, even to asystole), we have to immediately precede it with an
anti-cholinergic medication (glycopyrrolate or atropine) to block the
acetylcholine rush at muscarinic receptors in the autonomic nervous system
-- this then causes symptoms such as dry mouth, urinary retention, blurred
vision, tachycardia, etc.  Again, this is really only given at the end of a
surgery, when we're getting ready to wake up the patient.  Not so sure how
this might affect milk production...

We also very frequently need to give pressors during surgery, usually
ephedrine and/or phenylephrine; phenylephrine causes vasoconstriction while
ephedrine works more broadly to cause release of epinephrine and norepi, but
either of these might inhibit milk production.  I tend to have to use these
most often in younger healthy women (of lactating age!), usually near the
beginning of a case when they're deeply anesthetized and waiting for the
surgery to actually begin. 

Very rarely missing being at work,
Sarah Reece-Stremtan M.D. (gas-passer in training, out on long leave so I
can feed my baby)


On Mon, 28 Apr 2008 17:28:42 -0500, Kershaw Jane
<[log in to unmask]> wrote:

>Someone earlier mentioned experiences with moms NOT being excessively
>engorged etc after surgery.  One of the things that patients receive
>before general anesthesia (or any anesthesia) is something to help dry
>up secretions in the bronchial tree, to assist with anesthesia ( do we
>have any anesthesiologists on here?).  I have noticed in my experience
>working with these post-surgical moms, they do NOT tend to get engorged,
>maybe because of the drugs used to control secretions.  In fact, over
>the past 22 years I have been doing this in a hospital setting with
>surgical floors, I've never seen a mom past a month get into mastitis or
>engorgement issues from not expressing right after or during a surgery.
>That's just my observation.
>

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome