Is Propofol safe while breastfeeding?

Effects on the breastfed infant

Four mothers who were breastfeeding their infants received propofol as part of their general anesthesia for surgical procedures. All patients also received intravenous remifentanil and rocuronium, and inhaled xenon as part of the anesthesia. They were given doses of propofol that targeted a serum concentration of 6.5 mcg/L for induction and stopped as xenon anesthesia was started. Operation times ranged from 35 to 45 minutes. Individual infants were first breastfed as follows: 1.5 hours, 2.8 hours, 4.6 hours, and 5 hours after extubation. No signs of sedation were observed in any of the infants after their first feeding or at home after discharge.[ 8 ]

Effects on milk supply

Five women who were 6 to 15 weeks postpartum were given single doses of 2 mg of midazolam and 2.5 mg/kg of propofol intravenously before undergoing general anesthesia. The women's milk output following the surgical procedure was less than half of the normal milk output of nursing mothers. The authors speculated that milk volume might be reduced postoperatively because of perioperative fluid restriction and volume losses, as well as stress-induced inhibition of milk production.[ 3 ] A woman underwent emergency laparoscopic surgery using propofol as well as fentanyl, remifentanil, mivacurium, and dipyrone during the surgery and metamizole, piritramide, dipyrone, butylscopolamine, and metoclopramide postoperatively. Eight hours postoperatively, her milk turned bluish green, then green. Both propofol and metoclopramide have caused green urine. Thirty hours after the milk color change, propofol but not metoclopramide, was detected in milk.[ 7 ] 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. Fentanyl 1 to 1.5 mcg/kg was administered after delivery. 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.[ 9 ] A randomized, double-blind study compared the effects of intravenous propofol 0.25 mg/kg, ketamine 0.25 mg/kg, ketamine 25 mg plus propofol 25 mg, and saline placebo for pain control in mothers post-cesarean section in mothers post-cesarean section. A single dose

Levels in milk

Maternal Levels. Five women who had undergone general anesthesia with propofol intravenously shortly after delivery had colostrum propofol levels measured. All of the women received 2 mg/kg intravenously over 20 seconds at time zero followed by a continuous infusion. In 3 women who received 0.25 to 0.37 mg/kg/minute, propofol was detectable in colostrum, but not quantifiable because of technical difficulties. In a woman who received 0.42 mg/kg/minute for 7 minutes, the highest colostrum level was 1.53 mg/L at 15 minutes after the start of the infusion. Colostrum levels decreased to 0.12 mg/L over the next 8 hours. Another woman who received 0.18 mg/kg/minute for 6 hours, the highest colostrum level was 4.91 mg/L at 30 minutes after the start of the infusion.[ 6 ] Four women received a single intravenous bolus dose of propofol 2.5 mg/kg prior to cesarean section. Colostrum levels averaged 0.17 mg/L (range 0.14 to 0.24 mg/L) in 3 of the women 4 hours after the dose and 0.14 mg/L (range 0.089 to 0.19 mg/L) in 4 of the women 8 hours after the dose. In the same report, 3 women received a bolus dose of propofol 2.5 mg/kg followed by a continuous infusion of 5 mg/kg/hour. In one patient, colostrum level was 0.33 mg/L at 4 hours after the bolus; a second patient had levels of 0.74 mg/L at 5 hours and 0.048 mg/L at 8 hours after the bolus; a third patient had a colostrum level of 0.036 mg/L at 6 hours after the bolus.[ 2 ] Five women who were 6 to 15 weeks postpartum were given a single dose of 2.5 mg/kg of propofol intravenously before undergoing general anesthesia. Several milk samples were collected between 5 and 24 hours after the injection from each woman. The authors estimated that the infants would receive an average of 0.0052 mg/kg in the 24 hours after a single dose of propofol. This corresponds to 0.2% of the maternal weight-adjusted dosage. The women's milk output following the surgical procedure was less than half of the normal milk output of nursing mothers. The

Alternatives LactMed lists

• Dexmedetomidine
• Etomidate
• Methohexital
• Midazolam
• Thiopental