Can Mothers immediately breastfeed infants after Anesthesia ?

Brazil: Mothers are often advised to "pump-and-dump" their milk for 24 hours after they have undergone anesthesia to prevent the passage of the medication to the infant. This review, published in the Brazilian Journal of Anesthesiology highlights the more recent literature regarding anaesthetics transfer to breast milk.

The importance and benefits of breastfeeding for the babies and mothers are well established and documented in the literature. However, it is frequent that lactating mothers need to undergo general or spinal anaesthesia and, due to the lack of information, many of them interrupt breastfeeding after anaesthesia.

The study found that most of the anaesthetic drugs when administered in single-dose, are safe for nursing mothers and offer low risk to the breastfed neonates. However, high-dose and repeated administration of drugs significantly increase the risk of adverse effects on neonates. The authors, warns against the use of diazepam and meperidine in nursing women.

The importance and benefits of breastfeeding for both mothers and infants are well established and documented in the literature. In infants, it protects against a variety of infectious and illnesses complications, reduces children mortality, and improves neurological development. In mothers, it reduces the risk of ovarian and breast cancer, postpartum depression, and type 2 diabetes.

There are limited data available regarding anesthetics transfer to breast milk. The review by Murillo Gonçalves Santos, (UNESP), Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil, and colleagues aim to develop some considerations and recommendations based on available literature.

For the review, the researchers used health science databases Embase, Lilacs, Pubmed, Scopus, and Web of Science. An additional literature search was made via the World Health Organization's website. 599 registers were found, and 549 were excluded for different reasons. Fifty manuscripts have been included, with different designs of studies: prospective trials, retrospective observational studies, reviews, case reports, randomized clinical trials, case-control, and website access.

Also Read: Analgesia and anesthesia for the breastfeeding mother: ABM Guidelines

The authors found that:

• Small concentrations of the most anesthetic agents are transferred to the breast milk; however, their administration seems to be safe for lactating mothers when administered as a single dose during anesthesia and this should not contraindicate the breastfeeding.


• On the other hand, high-doses, continuous or repeated administration of drugs increase the risk of adverse effects on neonates and should be avoided.


• Few drugs, such as diazepam and meperidine, produce adverse effects on breastfed babies even in single doses.


• Dexmedetomidine seems to be safe if breastfeeding starts 24 h after discontinuation of the drug.

Also Read: Do fetuses over 21 weeks of gestation need anesthesia ?

"Anesthesiologists and pediatricians should consider individual risk/benefit, with special attention to premature neonates or babies with concurrent diseases since they are more susceptible to adverse effects," advise the authors.

For a detailed study follow the link: https://doi.org/10.1016/j.bjane.2018.12.006