Desflurane and Breastfeeding

Summary of use during lactation

There is no published experience with desflurane during breastfeeding. Because the serum half-life of desflurane in the mother is short and the drug is not expected to be absorbed by the infant, no waiting period or discarding of milk is required. Breastfeeding can be resumed as soon as the mother has recovered sufficiently from general anesthesia to nurse.[1] When a combination of anesthetic agents is used for a procedure, follow the recommendations for the most problematic medication used during the procedure. In one study, breastfeeding before general anesthesia induction reduced requirements of sevoflurane and propofol compared to those of nursing mothers whose breastfeeding was withheld or nonnursing women.[2] It is possible that requirements for other anesthetic agents would be affected similarly.

Drug levels in milk and infant serum

The serum half-life of desflurane is less than 3 minutes, so extensive passage into milk is unlikely. Maternal Levels. Relevant published information was not found as of the revision date. Infant Levels. Relevant published information was not found as of the revision date.

Effects in breastfed infants

Relevant published information was not found as of the revision date.

Effects on lactation and breastmilk

A randomized study compared the effects of cesarean section using general anesthesia, spinal anesthesia, or epidural anesthesia, to normal vaginal delivery on serum prolactin and oxytocin as well as time to initiation of lactation. General anesthesia was performed using propofol 2 mg/kg and rocuronium 0.6 mg/kg for induction, followed by sevoflurane and rocuronium 0.15 mg/kg as needed. After delivery, patients in all groups received an infusion of oxytocin 30 international units in 1 L of saline, and 0.2 mg of methylergonovine if they were not hypertensive. Fentanyl 1 to 1.5 mcg/kg was administered after delivery to the general anesthesia group. Patients in the general anesthesia group (n = 21) had higher post-procedure prolactin levels and a longer mean time to lactation initiation (25 hours) than in the other groups (10.8 to 11.8 hours). Postpartum oxytocin levels in the nonmedicated vaginal delivery group were higher than in the general and spinal anesthesia groups.[3] A retrospective study of women in a Turkish hospital who underwent elective cesarean section deliveries compared women who received bupivacaine spinal anesthesia (n = 170) to women who received general anesthesia (n = 78) with propofol for induction, sevoflurane for maintenance and fentanyl after delivery. No differences in breastfeeding rates were seen between the groups at 1 hour and 24 hours postpartum. However, at 6 months postpartum, 67% of women in the general anesthesia group were still breastfeeding compared to 81% in the spinal anesthesia group, which was a statistically significant difference.[4]

Alternative drugs to consider

Enflurane, Isoflurane, Sevoflurane

References

1. EsenerZ SarihasanB GuvenH Thiopentone and etomidate concentrations in maternal and umbilical plasma, and in colostrum. Br J Anaesth 1992 69 586 8 1467101 PubMed
2. BhaskaraB DayanandaVP KannanS Effect of breastfeeding on haemodynamics and consumption of propofol and sevoflurane: A state entropy guided comparative study. Indian J Anaesth 2016 60 180 6 27053781 PubMed
3. KutlucanL SekerIS DemiraranY Effects of different anesthesia protocols on lactation in the postpartum period. J Turk Ger Gynecol Assoc 2014 15 233 8 25584032 PubMed
4. KarasuD YilmazC OzgunaySE A comparison of the effects of general anaesthesia and spinal anaesthesia on breastfeeding. C R Acad Bulg Sci 2018 71 993 1000 10.7546/CRABS.2018.07.17