Anaesthesia and Breast-feeding – the Effect on Mother and Infant

Abstract

In this paper, we summarise the physiology of lactation and discuss the pathophysiology brought about by fasting, stress and anaesthetic drugs. Drug secretion into breast milk and subsequent absorption by the infant is considered. Maternal hydration must be well maintained with intravenous fluids, allowing an added 500 to 1000 ml for daily fluid loss in lactation. Maternal premedication, general anaesthesia and routine postoperative analgesics are also discussed as to the effects on the breast-fed infant. Drug side-effects may be avoided by timing breast feeding just before the next due dose. Sedatives with long half-lives should not be used. Endocrine and metabolic responses to anaesthesia and surgery are less with regional anaesthesia than with general, hence regional anaesthesia is preferred where it is a reasonable alternative technique.

Pharmacokinetics of midazolam, propofol, and fentanyl transfer to human breast milk

“…The prolonged delays in this study may reflect in part the timing of the collection of the first milk sample, which was 5 hours after drug administration to allow for the duration of anesthesia and surgery and the time to recover from the effects of anesthesia. Another factor contributing to the prolonged delay may have been reduced milk production seen after surgery because of perioperative fluid restriction and volume losses, as well as stress‐induced inhibition of milk production 26 . The reduced postoperative milk production may be especially reflected in the first (ie, 5‐hour) sample, the median volume of which was 10 mL (range, 3–80 mL), and, to a lesser extent, in the total volume collected in 24 hours, the median volume of which was 270 mL (range, 125–490 mL), which is less than half of the typical mature milk production by well‐nourished women in the first 6 months post partum 27 …”

“…Another factor contributing to the prolonged delay may have been reduced milk production seen after surgery because of perioperative fluid restriction and volume losses, as well as stress-induced inhibition of milk production. 26 The reduced postoperative milk production may be especially reflected in the first (ie, 5-hour) sample, the median volume of which was 10 mL (range, 3-80 mL), and, to a lesser extent, in the total volume collected in 24 hours, the median volume of which was 270 mL (range, 125-490 mL), which is less than half of the typical mature milk production by well-nourished women in the first 6 months post partum. 27 A potential limitation of this study is our failure to measure the metabolites of midazolam, propofol, and fentanyl.…”

The breast feeding mother and xenon anaesthesia: four case reports. Breast feeding and xenon anaesthesia

“…Accounts in the literature on the anaesthetic approach to nursing mothers are sparse [19,24,25]; guidelines do not reflect this setting, and textbooks recommend interruption of breast feeding for 24 h. Nor do the propofol and remifentanil SPCs (Summary of Product Characteristics) comment on usage during lactation.…”

Pregnancy and stroke

“…Although there are no data from large studies of aspirin use in the postpartum period, available evidence suggests that low-dose aspirin for stroke prevention is safe for the infant during breast-feeding [26][27][28]. Little information is available regarding the newer antiplatelet agents.…”