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

Abstract

BackgroundFour nursing mothers consented to anaesthesia for urgent surgery only on condition that their ability to breast feed would not be impaired.MethodsFollowing induction of general anaesthesia with propofol and remifentanil, 65-69% xenon supplemented with remifentanil was used as an inhalational anaesthetic for maintenance.ResultsAfter finishing surgery the women could be extubated between 2:52 and 7:22 minutes. The women were fully alert just minutes after extubation and spent about 45 minutes in the recovery room before discharge to a regular ward. They resumed regular breast feeding some time later. The propofol concentration in the blood was measured after 0, 30, 90, and 300 minutes and in the milk after 90 and 300 minutes. Just 90 minutes after extubation, the concentration of propofol in the milk was limited (> 3 mg/l) so that pharmacological effects on the babies were excluded after oral intake. Also, no traces of xenon gas were found in the maternal milk at any time. After propofol induction and maintenance of anaesthesia with xenon in combination with a water-soluble short-acting drug like remifentanil, the concentration of propofol in maternal milk is low (> 3 mg/l 90 min after anesthesia) and harmless after oral intake.ConclusionsThese results, as well as the rapid elimination and absence of metabolism of xenon, are of great interest to nursing mothers. General anaesthesia with propofol for induction only, combined with remifentanil and xenon for maintenance, has not yet been described in breast feeding mothers.

ABM Clinical Protocol #15: Analgesia and Anesthesia for the Breastfeeding Mother, Revised 2012

“…A recent series of case reports suggests that xenon maintenance after propofol induction allows for breastfeeding immediately after surgery. 49 3. The use of ketamine in breastfeeding mothers is unreported.…”

Safety of the breast‐feeding infant after maternal anesthesia

“…This drug is not available for use in anesthesia in the USA. In a report describing the use of general anesthesia with propofol, remifentanil and xenon in four breast‐feeding women, the xenon levels in the maternal milk were found to be zero immediately postextubation . Perhaps, in the future, use of xenon as a general anesthetic inhalational agent may prove beneficial to the breast‐feeding mother with early return to breast‐feeding as well as no effect on the breast‐fed infant (; LOE 3).…”

Xenon Anesthesia in Pediatric Dental Interventions

“…Анестезия ксеноном характеризуется быстрой индукцией и пробуждением, а также высоким качеством раннего послеоперационного периода, быстрым и полным восстановлением когнитивных функций [7][8][9][10][11][12][13][14]. Учитывая приоритетные свойства ксенона: анальгетическое, антистрессорное, седативное, кардио-и нейропротективное [15][16][17][18][19][20][21][22], его принадлежность к инертны газам и отсутствие до настоящего момента каких-либо известных токсических свойств при клиническом применении, представляется актуальным оценить возможности его использования в амбулаторной стоматологии у детей.…”