#WorldBreastfeedingWeek(1-7 August): New guidelines say brea
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Breastfeeding is safe after the mother has had anesthesia, as soon as she is alert and able to feed, suggest new guidelines published by the Association of Anaesthetists. The guidelines published in the journal Anaesthesia come at the start of World Breast Feeding Week (1-7 August).

Key Recommendations:
-- Women should be encouraged to breastfeed as normal following surgery. There is no need to express and discard breast milk after anesthesia.

-- Anaesthetic and non-opioid analgesic drugs are transferred to breast milk in only very small amounts. For almost all drugs used perioperatively, there is no evidence of effects on the breastfed infant.

-- Drugs such as opioids and benzodiazepines should be used with caution, especially after multiple doses and in babies up to 6 weeks old (corrected for gestational age). In this situation, the infant should be observed for signs of abnormal drowsiness and respiratory depression, especially if the woman is also showing signs of sedation.

-- Codeine should not be used by breastfeeding women following concerns of excessive sedation in some infants, related to differences in metabolism.

-- Any women with an infant less than 2 years should routinely be asked if they are breastfeeding during their pre-operative assessment.

-- Opioid-sparing techniques are preferable for the breastfeeding woman. Local and regional anesthesia have benefits in this regard, and also have the least interference with the woman’s ability to care for her infant.

-- Where possible, day surgery is preferable to avoid disrupting normal routines. A woman having day surgery should have a responsible adult stay with her for the first 24 h. She should be cautious with co-sleeping or sleeping while feeding the infant in a chair, as she may not be as responsive as normal.

-- Breastfeeding support should be accessible for lactating women undergoing surgical and medical procedures.

In summary, the pharmacological aspects of anesthesia and sedation require little alteration in breastfeeding women. However, supportive care for the woman in the peri-operative period, and accurate advice, will ensure minimal disruption to this important part of childcare.

Source: https://onlinelibrary.wiley.com/doi/full/10.1111/anae.15179
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