By Donnie Vinson, MD, Medical Director, CRH Anesthesia
A recent conversation with a CRNA in Florida shed light on anesthetics for nursing women. It is common for us to encounter breastfeeding mothers who choose to undergo sedation or general anesthesia for colonoscopy, upper endoscopy, and various other procedures.
Naturally, these patients have concerns about returning to breastfeeding following their anesthetic. It was previously recommended that women discard breast milk (“pump and dump”) immediately after surgery before they resumed breastfeeding. This outdated recommendation was made before data became available on the accumulation of drugs in breast milk, yet is still widely circulated on the internet, creating considerable confusion among patients and providers.
On October 23, 2019, the American Society of Anesthesiologists’ Committee on Obstetric Anesthesia approved a statement titled “Statement on Resuming Breastfeeding after Anesthesia.” The ASA statement provides evidence-based information so anesthesia providers can appropriately counsel nursing mothers on when they may safely resume breastfeeding and address concerns of adverse neonatal effects from medication exposure via breast milk.
The statement comes after the committee reviewed existing guidelines and analysis on the concentration of anesthetic drugs in breast milk. It summarizes relative infant dose (RID) values, which consider maternal and infant weight as well as drug concentration in breast milk. RID levels less than 10% are generally considered safe.
Reported RID values (%) for commonly used anesthetics include:
- Propofol: 0.1
- Lidocaine: 0.1
- Etomidate: 0.1
- Fentanyl: 1.0
- Midazolam: 0.3
- Morphine: 9
- Ketamine: Unknown (recommended only if medically necessary)
Two key recommendations from the ASA statement include:
- All anesthetic and analgesic drugs transfer to breast milk; however, only small amounts are present and at very low concentrations considered clinically insignificant.
- Patients should resume breastfeeding as soon as possible after surgery because anesthetic drugs appear in such low levels in breast milk. “Pump and dump” is not recommended.
The full ASA statement can be accessed here:
Statement on Resuming Breastfeeding after Anesthesia (asahq.org)
For further reference, see the October 2017 Anesthesiology article “Anesthesia and Breastfeeding: More Often Than Not, They Are Compatible”:
https://anesthesiology.pubs.asahq.org/article.aspx?articleid=2654616
