Anestesia materna deve atrasar a amamentação? Revisão sistemática da literatura

Oliveira, Morenna Ramos e; Santos, Murillo Gonçalves; Aude, Débora Alves; Lima, Rodrigo Moreira e; Módolo, Norma Sueli Pinheiro; Navarro, Laís Helena Camacho

doi:10.1016/j.bjan.2018.11.006

Cited by 6 publications

(14 citation statements)

References 44 publications

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“…In essence, we found data on two different 'fasting' patterns, with an acute model <24 h in 71 women [9][10][11], or a more chronic, repetitive fasting (during Ramadan) model in 81 women [12][13][14][15] ( Table 1). In our assessment, the acute model is likely very similar to the interruption of caloric intake as part of analgo-sedation related to surgery or diagnostic interventions and strongly suggests that this is not associated with changes in macronutrient composition [1][2][3][9][10][11]. Based on the data we retrieved, the impact of chronic repetitive fasting during Ramadan on breast milk is moderate but not clinically relevant (being mainly based on morning samples, so at the start of fasting), although there remains a call for further focused research on this topic.…”

Section: Discussionmentioning

confidence: 78%

“…Consequently, women may also want to breastfeed shortly following analgo-sedation for surgery or diagnostic procedures. To further facilitate this practice, guidelines are provided by different learned societies [1][2][3]. We also recently summarized the available knowledge on lactation during or after exposure to commonly prescribed analgesics, narcotics or sedatives (opioids, intravenous and inhalational anesthetics, benzodiazepines, non-opioid analgesics, and local anesthetics) following surgery, diagnostic procedures or medical indications [4].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Acute Maternal Fasting or Fluid Abstention Does Not Significantly Affect the Macronutrient Composition of Human Milk: Clinical and Clinical Research Relevance

Allegaert

Smits

2020

Children

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There are guidelines on lactation following maternal analgo-sedative exposure, but these do not consider the effect of maternal fasting or fluid abstention on human milk macronutrient composition. We therefore performed a structured search (PubMed) on ‘human milk composition’ and screened title, abstract and full paper on ‘fasting’ or ‘abstention’ and ‘macronutrient composition’ (lactose, protein, fat, solids, triglycerides, cholesterol). This resulted in six papers and one abstract related to religious fasting (n = 129 women) and observational studies in lactating women (n = 23, healthy volunteers, fasting). These data reflect two different ‘fasting’ patterns: an acute (18–25 h) model in 71 (healthy volunteers, Yom Kippur/Ninth of Av) women and a chronic repetitive fasting (Ramadan) model in 81 women. Changes were most related to electrolytes and were moderate and mainly in the chronic repetitive fasting model, with no clinical significant changes in macronutrients during acute fasting. We therefore conclude that neither short-term fasting nor fluid abstention (18–25 h) affect human milk macronutrient composition, so that women can be reassured when this topic was raised during consulting. Besides the nutritional relevance, this also matters, as clinical research samples—especially estimating analgo-sedative exposure by lactation—are commonly collected after maternal procedural sedation and maternal fasting. Based on these results, it is reasonable to assume stable human milk composition when such data are used in physiology-based pharmacokinetic (PBPK) models.

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Section: Discussionmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Acute Maternal Fasting or Fluid Abstention Does Not Significantly Affect the Macronutrient Composition of Human Milk: Clinical and Clinical Research Relevance

Allegaert

Smits

2020

Children

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“…Em razão disso, muitas mulheres suspendem a amamentação por falta de informação quanto a segurança dos anestésicos utilizados. 3 A passagem dos anestésicos para o leite materno, em grande parte dos casos são insignificantes e os riscos para as crianças que recebem o leite de mães após anestesia, são mínimos. 3,4 Diante disso, a interrupção da amamentação poderá ser mais deletéria para a criança do que o contato com mínimas concentrações de anestésicos.…”

Section: Introductionunclassified

“…3 A passagem dos anestésicos para o leite materno, em grande parte dos casos são insignificantes e os riscos para as crianças que recebem o leite de mães após anestesia, são mínimos. 3,4 Diante disso, a interrupção da amamentação poderá ser mais deletéria para a criança do que o contato com mínimas concentrações de anestésicos. 4 As pesquisas que envolvem passagem de anestésicos para o leite materno nos seres humanos são limitadas por comprometimentos éticos que envolvem os estudos com mães e crianças.…”

Section: Introductionunclassified

Avaliação Da Segurança Dos Anestésicos Venosos Em Pacientes Lactantes

Antunes Júnior,

Leite

2024

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Este artigo apresenta uma análise detalhada sobre a segurança dos anestésicos venosos em pacientes lactantes, destacando a relevância do aleitamento materno para a saúde infantil e materna e abordando as preocupações com a transferência de anestésicos para o leite materno. A revisão da literatura foi conduzida em várias bases de dados, resultando na seleção de 22 publicações pertinentes. O estudo abrange diversas classes de fármacos anestésicos, incluindo agentes sedativos como alfa2 agonistas, benzodiazepínicos e hipnóticos, além de opioides. Cada classe é analisada quanto à sua passagem para o leite materno e possíveis efeitos em lactentes. Entre os sedativos, a Dexmedetomidina e os benzodiazepínicos como Diazepam e Midazolam são discutidos, com recomendações específicas sobre seu uso seguro. Hipnóticos como Etomidato, Cetamina e Propofol também são avaliados, enfatizando a rápida depuração e segurança no uso em mães lactantes. Nos opioides, a morfina é mencionada como segura em dose única, enquanto o uso de Tramadol é desaconselhado devido ao risco de sedação e depressão respiratória nos lactentes. Fentanil e seus derivados, como Alfentanil, Sufentanil e Remifentanil, são considerados seguros em doses únicas, com mínima transferência para o leite materno. Os resultados do estudo enfatizam a importância do aleitamento materno, indicando que a transferência dos anestésicos venosos para o leite é geralmente insignificante em doses únicas, não representando riscos para lactentes saudáveis. Entretanto, o artigo ressalta que lactentes com comorbidades ou prematuros podem ter maior risco de efeitos colaterais, e recomenda que cada caso seja avaliado individualmente pelo anestesista e pediatra, considerando o risco/benefício.

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“…Consequently, women also want to breastfeed shortly following analgo-sedation for surgery or diagnostic procedures. To further facilitate this practice, guidelines are provided by different associations [1,2,3]. We also recently summarized the available knowledge on lactation during or after exposure to commonly prescribed analgesics, narcotics or sedatives (opioids, intravenous and inhalational anesthetics, benzodiazepines, non-opioid analgesics, and local anesthetics) following surgery, diagnostic procedures or medical indications.…”

Section: Introductionmentioning

confidence: 99%

Maternal Fasting or Fluid Abstention Does Not Significantly Affect the Macronutrient Composition of Human Milk: Clinical and Clinical Research Relevance

Allegaert¹,

Smits²

2020

Preprint

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There are guidelines on lactation following maternal analgo-sedative exposure, but these do not consider the effect of maternal fasting, nor fluid abstention on human milk macronutrient composition. We therefore performed a structured search (PubMed) on ‘human milk composition’ and screened title, abstract and full paper on ‘fasting’ or ‘abstention’ and ‘macronutrient composition’ (lactose, protein, fat, solids, triglycerides, cholesterol). This resulted in 6 papers and one abstract related to religious fasting (n=129 women) and observational studies in lactating women (n=23, healthy volunteers, fasting). These data reflect two different ‘fasting’ patterns: an acute (18-25h) model in 71 (healthy volunteers, Yom Kippur/Ninth of Av) women and a chronic fasting (Ramadan) model in 81 women. Changes were most related to electrolytes and were moderate, with almost no changes in macronutrients during acute fasting. We therefor conclude that neither short term fasting nor fluid abstention (18-25h) affect human milk macronutrient composition, so that women can be reassured when this topic were raised during consulting. Besides the nutritional relevance, this also matters as clinical research samples – especially to estimate analgo-sedative exposure by lactation - are commonly collected after maternal procedural sedation, associated with maternal fasting and physiology-based pharmacokinetic (PBPK) models assume stable human milk composition.

show abstract

Anestesia materna deve atrasar a amamentação? Revisão sistemática da literatura

Cited by 6 publications

References 44 publications

Acute Maternal Fasting or Fluid Abstention Does Not Significantly Affect the Macronutrient Composition of Human Milk: Clinical and Clinical Research Relevance

Acute Maternal Fasting or Fluid Abstention Does Not Significantly Affect the Macronutrient Composition of Human Milk: Clinical and Clinical Research Relevance

Avaliação Da Segurança Dos Anestésicos Venosos Em Pacientes Lactantes

Maternal Fasting or Fluid Abstention Does Not Significantly Affect the Macronutrient Composition of Human Milk: Clinical and Clinical Research Relevance

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