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Subject:
From:
Sarah Reece-Stremtan <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 8 Sep 2009 00:04:46 -0400
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Sorry I'm a bit late here but wanted to clarify a couple things about
anesthesia.

To be honest, I don't think there's a very clear-cut reason for why mom's
milk supply should drop when undergoing anesthesia -- it is likely a
response to the huge physiologic stress of the surgery itself, even though
time and again we hear of moms breastfeeding through enormous stressors and
doing fine.  The general purpose of providing anesthesia is to try to
minimize that stress response.

Possible culprits, though, for academic purposes :) would be:

*ephedrine:  this is a drug that when given intravenously only lasts a few
minutes.  It is both a relatively non-specific alpha and beta agonist and an
indirectly acting enhancer of endogenous catecholamine release.  So I give
it to raise blood pressure, and probably end up using it in almost half of
my cases.  

*phenylephrine:  a peripherally acting alpha agonist that causes
vasoconstriction (also, incidentally now the "pseudoephedrine substitute"
available over-the-counter as a cold remedy because you can't use it to make
methamphetamine).  I also use it very frequently to raise blood pressure,
and it is extremely short-acting.

*glycopyrrolate:  this is probably what was referred to as being given to
"dry up secretions."  It is an anti-cholinergic, which is used to counteract
the bradycardic and other effects of neostigmine, which is an
anticholinesterase that is given to reverse the effects of muscle relaxants
(confused yet???)  Same class as atropine but lasts a little longer and does
not cross the blood-brain barrier and cause wackiness.  We rarely give it
for the sole purpose of drying out secretions but absolutely have to dose it
to prevent asystole when we've used muscle relaxants that need to be reversed.  

I'm not sure that any of those meds would be responsible for the drastic
drop in milk supplies that so many of you have described, but I can't think
of any others that may have an impact -- induction agents, anesthetic gases,
benzos, narcotics, and muscle relaxants shouldn't.  Oh, mannitol is what we
give during neurosurgical procedures where we need help to "shrink" the
brain, and it is an osmotic diuretic that helps to draw water out of the
brain tissue.  But I think I've only give it once ever in a non-neuro case.

Hope that helps a bit.
-Sarah Reece-Stremtan M.D. (gas-passer in Washington DC)

On Thu, 3 Sep 2009 10:24:03 -0500, Kershaw Jane
<[log in to unmask]> wrote:

>Also, remember when brain surgery is done and actually almost any surgery
where anesthesia is used, medications are given to dry up secretions.  Think
about how we tell moms not to use pseudoephedrine because it can "dry up"
the milk.  After brain surgery, patients are given medications to decrease
brain swelling, a severe problem, as you might imagine.  These medications
would probably have an impact on milk production.  I used to work in a neuro
intensive care many lifetimes ago (before life as an OB nurse, NICU nurse,
OB critical care nurse, then migrating to lactation - giving away my age
here).  I'm rusty on my drugs and I'm sure there have been lots of changes,
but the physiology and rationale cannot be all that different now.  In the
hospital where I work now, we are often called to help moms post-surgeries.
 Never really seen an engorgement issue, have seen decreased supplies.  But
these usually bounce back with keeping the prolactin receptors open through
stimulation and removal of whatever milk is there by breastfeeding and/or
pumping.
>

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