How long after anaesthesia with propofol, midazolam and flumazenil does breast-feeding have to be s

Fråga: How long after anaesthesia with propofol, midazolam and flumazenil does breast-feeding have to be stopped?

The question concerns a lactating woman, with a 7-month-old child, who has to be subjected to a short general anaesthesia.

Sammanfattning: Propofol can be traced in breastmilk after use in a short general anesthesia, but is considered safe for healthy children. Midazolam in a single dose is compatible with breastfeeding. There are no available data on flumazenil and breast-feeding, but based on its pharmacokinetic properties it should be eliminated from the blood after five hours, after which breast-feeding can be resumed.

Svar: The drug information centres have previously answered questions concerning breast-feeding and anaesthesia with propofol. Traces of propofol are found in breast milk after a short general anesthesia, but the amount is negligible and nursing is considered safe for healthy children (1). An updated search on Medline did not reveal any additional information.

Midazolam is secreted in very low concentrations, and breast-feeding after a single dose is considered safe (2).

Flumazenil is an imidazobensodiazepin released for clinical use in 1991, which acts as a bensodiazepine antagonist. It is used to reverse the sedative effects of bensodiazepines given during general anaesthesia and in cases of bensodiazepine overdose. According to the Swedish catalogue of approved drugs (3) the data concerning the secretion of flumazenil in breast milk are insufficient. There was no information on breast-feeding and flumazenil in the standard reference literature, nor did a search on Medline yield any information. The conclusion therefore has to be made on the pharmacokinetic properties of flumazenil. The plasma half-life of flumazenil is approximately 60 minutes. Over 95% of a drug is usually eliminated after five times its plasma half-life. It is therefore likely that it would be safe to breast-feed five hours after the single dose injection of flumazenil. To be on the safe side, it is recommended that the patient use a vaccumpump immediately prior to anaesthesia. This portion can then be given to the child by bottle during the first postoperative hours. As a safety precaution, the first portion of milk after anaesthesia can be pumped and discarded. 1 Drugline no 08360 (year 1991) 2 Drugline no 08363 (year 1991) 3 FASS 2002 (The Swedish catalogue of approved medical products)