Anesthesia and breastfeeding

Abstract

The importance of breastfeeding with its positive impact on the wellbeing of the mother-infant pair is well established. Anesthesiologists should encourage the promotion of lactation by being willing to give reassurance during the preoperative period and preparing a plan that does not interfere with safe breastfeeding. There is concern regarding the transfer of drugs into breast milk, which may lead to inconsistent advice from many health professionals and to early discontinuation. However, evidence shows that most anesthetic drugs are safe in terms of transfer into breast milk, and hence, compatible with breastfeeding, which should be resumed after anesthesia as soon as the mother is alert and feels well enough to hold her infant, without the need to “pump and dump”. This review provides pharmacokinetic information on commonly used anesthesia drugs and their passage into breast milk, to help practitioners discuss risks and benefits with the mother, emphasizing that anesthesia should not interfere with the benefits of breastfeeding. Four practical clinical scenarios are presented: pregnant women concerned about the effect of epidural analgesia on subsequent breastfeeding, spinal anesthesia for c-section and lactation, patients who will receive general anesthesia during cesarean section, and finally women who are breastfeeding and require anesthesia for elective or urgent surgery. Neuraxial anesthesia allows for better pain control and immediate skin-to-skin contact at the time of childbirth. Also, it interferes the least with the woman’s ability to care for her infant. Regional techniques, opioid-sparing techniques and outpatient surgery are preferred. Drugs such as opioids and longer-acting benzodiazepines should be administered cautiously, particularly in repeat doses.

Perbedaan Konsentrasi Levobupivakain Isobarik pada Blok Transverse Abdominis Plane terhadap Intensitas Nyeri dan Kadar Beta Endorfin pada Pasien Pasca Seksio Sesarea

“…Selain efek samping dari opioid sistemik tersebut, hal lainnya yang dikhawatirkan adalah adanya transmisi obat opioid melalui ASI walaupun ada beberapa jenis obat opioid yang aman digunakan oleh ibu menyusui. 14 Penggunaan morfin intratekal memiliki efek analgesia yang lebih baik jika dibandingkan dengan blok TAP, akan tetapi memiliki lebih banyak efek samping seperti mual, muntah, dan pruritus. [15][16][17] Penggunaan blok TAP dikombinasikan dengan morfin intratekal tidak direkomendasikan karena tidak didapatkan adanya perbedaan yang signifikan dengan penggunaan morfin intratekal saja.…”