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There is a physician at our hospital that is now insisting that c-section moms that have been given sevoflurane as a part of general anesthesia must pump and dump their milk for 24 hours. We have read the listing in Medications and Mothers' Milk but is there anything else you can add to help educate this doctor?
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wicic:
This is my response. I don't see the problem with feeding early postnatally.
Tom Hale Ph.D.
Sevoflurane is a gaseous halogenated general anesthetic drug that is particularly popular because of its rapid wash-out. Average patient time to emergence is approximately 8.2 minutes. It is commonly used in adult and pediatric patients, and is used in cesarean sections. The manufacturer states that while the concentration of sevoflurane have not been measured in breastmilk, they are probably of no clinical importance 24 hours after anesthesia. Because of its rapid wash-out, sevoflurane concentrations in milk are predicted to be below those found with many other volatile anesthetics.[1] Sevoflurane follows a three term exponential decay with half-lives of 11 min (18% of the dose in plasma compartment), 1.8 hours (15% from muscle compartment), and 20 hours (6% from fat compartment).[2] Small (3%) amounts of sevoflurane are metabolized and result in plasma levels that average 36 ?M/L. Levels reported are temporary and completely dissipate by 6 days. The fluoride ion released is not high enough to be a contraindication to breastfeeding. Further, the oral absorption of fluoride in infants is believed poor as it is chelated with calcium ions orally in milk.
While no data on levels of sevoflurane in breastmilk are available, this product, due to its rapid clearance from the body (100-fold drop in 120 minutes), should not pose a problem for continued breastfeeding soon after exposure.
1.Pharmaceutical manufacturer prescribing information, 2003.
2.Holaday DA, Smith FR. Clinical characteristics and biotransformation of sevoflurane in healthy volunteers. Anesthesiology 1981; 54:100-106.
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