Is Rocuronium Safe in Breastfeeding

I am a breastfeeding mother and i want to know if it is safe to use Rocuronium? Is Rocuronium safe for nursing mother and child? Does Rocuronium extracts into breast milk? Does Rocuronium has any long term or short term side effects on infants? Can Rocuronium influence milk supply or can Rocuronium decrease milk supply in lactating mothers?

It is a non-depolarizing muscle relaxant drug with a peripheral action that is used as premedication for endotracheal intubation, general anesthesia and mechanical ventilation. Breastfed infants have not shown any problem after 1.5 to 5 hours of anesthesia time period with Rocuronio (additional drugs like Propofol, Remifentanil and Xenon were used). A high molecular weight may decrease excretion into breast milk as well as a rapid elimination time. In addition, a low oral bioavailability makes unlikely a pass from ingested mother's milk onto the infant's plasma. Rocuronium should not prevent a mother from breast feeding her baby shortly after recovering from an anesthesia if she is in good condition.

Limited information on the use of rocuronium during breastfeeding indicates that no adverse infant effects occur. Because it is short acting, highly polar and poorly absorbed orally, it is not likely to reach the breastmilk in high concentration or to reach the bloodstream of the infant.[1][2] When a combination of anesthetic agents is used for a procedure, follow the recommendations for the most problematic medication used during the procedure. General anesthesia for cesarean section using rocuronium as a component may delay the onset of lactation.

Four mothers who underwent general anesthesia were given propofol and remifentanil as induction agents and rocuronium for intubation. After induction, propofol was stopped and xenon inhalation was used to maintain anesthesia for between 57 and 70 minutes. Infants resumed breastfeeding from 1.5 to 5 hours after the end of surgery. None of the infants had noticeable symptoms of dizziness or drowsiness. All infants fared well at home after their mothers were discharged.[3]

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.[4]