Breastfeeding after Anaesthesia: A Review of the Pharmacological Impact on Children

Chu, Tony; McCallum, J; Yii, Ming Fong

doi:10.1177/0310057x1304100107

Cited by 13 publications

(7 citation statements)

References 52 publications

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“…Our study chose fentanyl as rescue analgesia due to its minimal excretion into breast milk, therefore it is safer to use in postoperative cesarean section mothers who are planning to breastfeed (20). This study also showed a significant difference in the total consumption of fentanyl in patients who received ketamine.…”

Section: Resultsmentioning

confidence: 81%

Low-Dose Ketamine as Perioperative Analgesia in Caesarean Sections in Remote Areas with Limited Medical Supplies

Avidar

Salinding

Hamzah

et al. 2022

IJAR

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Introduction: Cesarean section is the most common surgical procedure performed in the world and its postoperative pain is still a major issue in several countries. In a low-resource setting, this management poses a challenge for anesthesiologists. Ketamine is the most used anesthetic drug in the world due to its easy access and proven benefits. Objective: This research aims to analyze the effectiveness of low-dose ketamine as postoperative analgesia in cesarean sections conducted in areas with limited medical supplies. Materials and Methods: A Randomized Controlled Trial (RCT) was done from August 2020 to January 2021 with consenting pregnant patients who had undergone cesarean section. The sampled population was randomized to receive either ketamine intravenously or a placebo before the Subarachnoid Block (SAB). Low dose ketamine was divided into three groups 0.15 mg/kg, 0.25 mg/kg, and 0.5 mg/kg. The outcome was divided into primary outcome (pain score after 1-hour post-operation, 2 hours post-operation, 24 hours post-operation, and 48 hours post-operation) and secondary outcome (Apgar Score in the first minute and 5 minutes, hypotension after SAB, sedative effect during operation, postoperative nausea vomiting, time to receive opioid postoperative as rescue analgesia and total opioid uses). Results and Discussion: This study screened 105 patients and recruited 90 patients that were randomized into two groups consisting of 45 patients that received either low-dose ketamine or a placebo. The groups administered ketamine showed a lower pain score in 1 hour (p-value = 0.0037) and 2 hours post-operation (p-value = 0.0037). They also showed that it could prolong the administration of fentanyl (p-value = 0.0003) and lower total fentanyl used (p-value = 0.0008). The groups administered ketamine showed that there was a sedation effect (p-value = 0.0001) that depended on the dosage used. Conclusion: Intravenous ketamine with low doses can reduce pain scores at 1 hour to 2 hours post-operation and shows the need to reduce opioid requirements.

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Section: Resultsmentioning

confidence: 81%

Low-Dose Ketamine as Perioperative Analgesia in Caesarean Sections in Remote Areas with Limited Medical Supplies

Avidar

Salinding

Hamzah

et al. 2022

IJAR

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“…Current recommendations are mostly defined based on the pharmacodynamics and pharmacokinetics of medication, limited studies of milk concentrations and rare effects on infants [ 2 ]. Nevertheless, multiple published guidelines conclude that most mothers can safely breastfeed following anesthesia when they are awake and alert [ 2 , 3 , 4 , 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Health Care Providers’ Perspective and Knowledge about Peri-Surgical Medication and Practices in Breastfeeding Women

Hondt

Gorsen

Verburgh

et al. 2023

IJERPH

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Many guidelines offer recommendations to support the continuation of breastfeeding and the choice of medication when a mother undergoes a surgical procedure. The aim of this study is to investigate health care providers’ (HCPs) current practices and knowledge about peri-surgical medication and practices in breastfeeding women. We performed a cross-sectional study in Flanders (Belgium) assessing demographics, beliefs about breastfeeding and its health benefits, current practices concerning breastfeeding women undergoing (surgical) procedures and specific knowledge about the use of medication during breastfeeding. Two hundred and ninety-one (291) participants completed the online questionnaire. Many participants considered their knowledge about breastfeeding to be good, and almost all participants acknowledged the superiority of breastfeeding and the importance of its continuation. Very few participants were, however, familiar with the available protocols concerning surgical procedures in breastfeeding women. Less than half of the participants routinely advised the recommended practices to protect breastfeeding. For most of the peri-surgical medication, participants needed to look-up information about the compatibility with breastfeeding. We conclude that there is a knowledge gap and recommend the development of a comprehensive guideline as well as implementation of this information in basic and post-academic training.

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“…Over-cautious guidelines may unnecessarily withhold breastmilk, anesthesia, or operative procedures in the setting of lactation, while under-cautious guidelines may expose infants to dangerous levels of drugs via breast milk. Due to the short half-life, minimal presence in breast milk, and limited oral bioavailability of many anesthetic agents, once a mother is awake and able to breastfeed her baby, breastfeeding after anesthesia is generally considered safe [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

“…Despite over 50 years of clinical use [9] and wide availability in low-and middle-income countries, including for caesarean section, there is no data in the scientific literature on the safety of ketamine in lactation [2][3][4][5]. Ketamine's sympathomimetic effects prevent the hypotension and apnea associated with other anesthetic agents, allowing for its use in settings without capacity for mechanical ventilation or administration of vasopressors [10].…”

Section: Introductionmentioning

confidence: 99%

Outcomes for 298 breastfed neonates whose mothers received ketamine and diazepam for postpartum tubal ligation in a resource-limited setting

Gilder

Tun

Carter

et al. 2021

BMC Pregnancy Childbirth

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Background Anesthesia in lactating women is frequently indicated for time-sensitive procedures such as postpartum tubal ligation. Ketamine and diazepam are two of the most commonly used anesthetic agents in low resource settings, but their safety profile in lactating women has not been established. Methods Medical records of post-partum tubal ligations between 2013 and 2018 at clinics of the Shoklo Malaria Research Unit were reviewed for completeness of key outcome variables. Logistic regression identified presence or absence of associations between drug doses and adverse neonatal outcomes: clinically significant weight loss (≥95th percentile) and neonatal hyperbilirubinemia requiring phototherapy. Results Of 358 records reviewed, 298 were lactating women with singleton, term neonates. There were no severe outcomes in mothers or neonates. On the first postoperative day 98.0% (290/296) of neonates were reported to be breastfeeding well and 6.4% (19/298) had clinically significant weight loss. Phototherapy was required for 13.8% (41/298) of neonates. There was no association between either of the outcomes and increasing ketamine doses (up to 3.8 mg/kg), preoperative oral diazepam (5 mg), or increasing lidocaine doses (up to 200 mg). Preoperative oral diazepam resulted in lower doses of intraoperative anesthetics. Doses of intravenous diazepam above 0.1 mg/kg were associated with increased risk (adjusted odds ratio per 0.1 mg/kg increase, 95%CI) of weight loss (1.95, 95%CI 1.13–3.35, p = 0.016) and jaundice requiring phototherapy (1.87, 95%CI 1.11–3.13, p = 0.017). Conclusions In resource-limited settings ketamine use appears safe in lactating women and uninterrupted breastfeeding should be encouraged and supported. Preoperative oral diazepam may help reduce intraoperative anesthetic doses, but intravenous diazepam should be used with caution and avoided in high doses in lactating women.

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Breastfeeding after Anaesthesia: A Review of the Pharmacological Impact on Children

Cited by 13 publications

References 52 publications

Low-Dose Ketamine as Perioperative Analgesia in Caesarean Sections in Remote Areas with Limited Medical Supplies

Low-Dose Ketamine as Perioperative Analgesia in Caesarean Sections in Remote Areas with Limited Medical Supplies

Health Care Providers’ Perspective and Knowledge about Peri-Surgical Medication and Practices in Breastfeeding Women

Outcomes for 298 breastfed neonates whose mothers received ketamine and diazepam for postpartum tubal ligation in a resource-limited setting

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