Is Sevoflurane Safe in Breastfeeding

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

Volatile halogenated anesthetic administered by inhalation. Since the last update we have not found published data on its excretion in breast milk. 95% is excreted via the lung without having been metabolized.Several authors believe that the amount excreted in milk is minimal, therefore it is considered safe during breastfeeding (Dalal 2014, Hale 1999, Spigset 1994), as well as another anesthetic from the same family, halothane, which is considered compatible with breastfeeding by the American Academy of Pediatrics.The residual amount of fluoride that is produced is minimal and is chelated by the calcium in the milk. Given its rapid elimination from the body, it is possible to breastfeed as soon as the mother has recovered from the anesthesia. Breastfeeding before anesthesia reduces the need for sevoflurane and also propofol to maintain the anesthesia (Bhaskara 2016).General anesthesia in caesarean sections delays the start of breastfeeding with respect to epidural anesthesia (Kutlucan 2014).Professionals working in the operating rooms may inhale volatile anesthetics which may appear in milk from breastfeeding mothers (Cote 1976), but in clinically insignificant amounts, therefore breastfeeding is not contraindicated.

There is little published experience with sevoflurane during breastfeeding. Because the serum half-life of sevoflurane in the mother 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. General anesthesia for cesarean section using sevoflurane as a component may delay the onset of lactation. 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]

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]