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Anästhesiol Intensivmed Notfallmed Schmerzther 2000; 35(6): 356-374
DOI: 10.1055/s-2000-3770
ÜBERSICHT
Georg Thieme Verlag Stuttgart · New York

Anästhesie in der Stillzeit

Welche Einschränkungen sind gerechtfertigt?P. Schneider, P. Reinhold
  • Klinik für Anaesthesiologie, operative Intensivmedizin, Schmerztherapie Klinikum Kreis Herford, Herford
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Publication History

Publication Date:
31 December 2000 (online)

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Zusammenfassung.

Obwohl in den letzten Jahren das Wissen über die Exkretion von Medikamenten in die Muttermilch erheblich zugenommen hat, sind die Informationen über viele anästhesierelevante Medikamente weiterhin lückenhaft. Insbesondere die Kenntnis über mögliche unerwünschte Wirkungen auf den Säugling ist unzureichend. In dieser Arbeit erfolgt nach einer Beschreibung der pharmakokinetischen Prinzipien des Medikamentenübertritts in die Muttermilch eine detaillierte Darstellung des derzeitigen Wissenstandes für perioperativ gebräuchliche Medikamente. Eine Narkose ist kein obligater Grund abzustillen. Denn es ist möglich, eine Anästhesie bei einer stillenden Mutter durchzuführen, ohne auf die Vorzüge der Muttermilchernährung verzichten zu müssen. Bei sorgfältiger Auswahl der Medikamente müssen auch elektive chirurgische Eingriffe nicht verschoben werden, und das Stillen kann in der unmittelbaren postoperativen Periode wiederaufgenommen werden.

Anaesthesia During Breast Feeding - Which Restrictions are Justified.

In the Iast years knowledge of the excretion of drugs into breast milk has increased significantly. But information concerning anesthetic and analgesic drugs seems to be dispersed and limited. This paper describes the pharmacokinetic principles of drug transfer to milk and offers a comprehensive survey for drugs used in the perianesthetic period. The necessity of anesthesia should never be a sufficient reason to quit breast-feeding. With the information given in this article the individual duration of breast-milk-free interval can be discussed. Thus it will be possible to anesthetize a breast-feeding mother with minimal risks for the child without giving up the advantages of mother milk. Through careful selection of appropriate drugs even elective operations don't need to be postponed and breastfeeding can be continued as soon as in the immediate postoperative period.

Schlüsselwörter:

Anästhesie - Narkose - Muttermilch - Stillen - Kolostrum - Säugling - Laktation

Key words:

Anesthesia - Breast-feeding - Breast milk - Colostrum - Infant - Lactation

Literatur

  • 1 Hanson L A, Hahn-Zoric M, Berndes M, Ashraf R, Herias V, Jalil F, Bhutta T I, Laeeq A, Mattsyby-Baltzer I. Breast feeding: overview and breast milk immunology.  Acta Paediatr. Jpn.. 1994;  36 557-561
    PubMedGoogle Scholar
  • 2 Golding J, Emmett P M, Rogers I S. Does breast feeding have any impact an non-infectious, non-allergic disorders?.  Early. Hum. Dev.. 1997;  49 (Suppl.) S131-S142
    CrossrefPubMedGoogle Scholar
  • 3 Andersen L W, Qvist T, Hertz J, Mogensen F. Concentration of thiopentone in mature breast milk and colostrum following an induction dose.  Acta Anaesthesiol. Scand.. 1987;  31 30-32
    PubMedGoogle Scholar
  • 4 Bennett P N. Drugs and Human Lactation. Second Edition. Elsevier Science B.V, Amsterdam 1989
    Google Scholar
  • 5 Borgatta L, Jenny R W, Gruss L, Ong C, Barad D. Clinical significance of methohexital, meperidine, and diazepam in breast milk.  J. Clin. Pharmacol.. 1997;  37 186-192
    PubMedGoogle Scholar
  • 6 Dailland P, Cockschott I D, Lirzin J D, Jacquinot P, Jorrot J C, Devery J, Harmey J L, Conseiller C. Intravenous propofol during cesarean section: placental transfer, concentrations in breast milk, and neonatal effects. A preliminary study.  Anesthesiology.. 1989;  71 827-834
    PubMedGoogle Scholar
  • 7 Schmitt J P, Schwoerer D, Diemunsch P, Gauthier-Lafaye J. Passage du propofol dans le colostrum. Donnee¿s preliminaires.  Ann. Fr. Anesth. Reanim. (Paris). 1987;  6 267-268
    PubMedGoogle Scholar
  • 8 Esener Z, Sarihasan B, Güven H, Üstün E. Thiopentone and etomidate concentrations in maternal and umbilical plasma, and in colostrum.  Br. J. Anaesth.. 1992;  69 586-588
    PubMedGoogle Scholar
  • 9 Matheson I, Lunde P K, Bredesen J E. Midazolam and nitrazepam in the maternity ward: milk concentrations and clinical effects.  Br. J. Clin. Pharmacol.. 1990;  30 787-793
    CrossrefPubMedGoogle Scholar
  • 10 Brandt R. Passage of diazepam and desmethyldiazepam into breast milk.  Arzneimittelforschung. 1976;  26 454-457
    PubMedGoogle Scholar
  • 11 Erkkola R, Kanto J. Diazepam and breast-feeding.  Lancet. 1972;  1 (7762) 1235-1236
    PubMedGoogle Scholar
  • 12 Patrick H J, Tilstone W J, Reavey P. Diazepam and breastfeeding.  Lancet. 1972;  1 (7749) 542-543
    PubMedGoogle Scholar
  • 13 Wesson D R, Cambe S, Harkey M, Smith D E. Diazepam and desmethyldiazepam in breast milk.  J. Psychoact. Drugs. 1985;  17 55-56
    PubMedGoogle Scholar
  • 14 Dusci L J, Good S M, Hall R W, Ilett K F. Excretion of diazepam and its metabolites in human milk during withdrawal from combination high dose diazepam and oxazepam.  Br. J. Clin. Pharmacol.. 1990;  29 123-126
    PubMedGoogle Scholar
  • 15 Rey E, Giraux P, d'Athis Ph, Turquais J M, Chavinie J, Olive G. Pharmacokinetics of the placental transfer and distribution of chlorazepate and its metabolite nordiazepam in the feto-placental unit and in the neonate.  Eur. J. Clin. Pharmacol.. 1979;  15 181-185
    CrossrefPubMedGoogle Scholar
  • 16 Wretlind M. Excretion of oxazepam in breast milk.  Eur. J. Clin. Pharmacol.. 1987;  33 209-210
    CrossrefPubMedGoogle Scholar
  • 17 Jensen O H, Bredensen J E, Lindbaek E. Transfer of flunitrazepam to mothers milk.  Tiddskr. Nor. Laegeforen.. 1981;  101 504-505
    PubMedGoogle Scholar
  • 18 Kanto J, Aaltonen L, Langas L, Erkkola R, Pitkänen Y. Placental transfer and breast milk levels of flunitrazepam.  Curr. Ther. Res.. 1979;  26 539-546
    PubMedGoogle Scholar
  • 19 Feilberg V L, Rosenborg D, Broen Christensen C, Mogensen J V. Excretion of morphine in human breast milk.  Acta Anaesthesiol. Scand.. 1989;  33 426-428
    PubMedGoogle Scholar
  • 20 Wittels B, Scott D T, Sinatra R. Exogenous opioids in human breast milk and acute neonatal neurobehavior: A preliminary study.  Anesthesiology. 1990;  73 864-869
    PubMedGoogle Scholar
  • 21 Robieux I, Koren G, Vandenbergh H, Schneiderman J. Morphine excretion in breast milk and resultant exposure of nursing infant.  J. Toxicol. Clin. Toxicol.. 1990;  28 365-370
    PubMedGoogle Scholar
  • 22 Zakowski M I, Ramanathan S, Turndorf H. A two-dose epidural morphine regimen in cesarean section patients: a pharmacokinetic profile.  Acta Anaesthesiol. Scand.. 1993;  37 584-589
    PubMedGoogle Scholar
  • 23 Spigset O. Anaesthetic agents and excretion in breast milk.  Acta Anaesthesiol. Scand.. 1994;  38 94-103
    CrossrefPubMedGoogle Scholar
  • 24 Giesecke A H, Rice L J, Lipton J M. Alfentanil in colostrum.  Anesthesiology. 1985;  63 A284
    PubMedGoogle Scholar
  • 25 Gauntlett I S, Fisher D M, Hertzka R E, Kuhls E, Spellmann M J, Rudolph C. Pharmacokinetics of fentanyl in neonatal humans and lambs: effects of age.  Anesthesiology. 1988;  69 683-687
    PubMedGoogle Scholar
  • 26 Leuschen M P, Wolf L J, Rayburn W F. Fentanyl excretion in breast milk.  Clin Pharm.. 1990;  9 336-337
    PubMedGoogle Scholar
  • 27 Steer P L, Biddle C J, Marley W S, Lantz R K, Sulik P L. Concentration of fentanyl in colostrum after an analgesic dose.  Can. J. Anaesth.. 1992;  39 231-235
    CrossrefPubMedGoogle Scholar
  • 28 Biddle C. ls it okay to breast feed my baby after anaesthesia. A scientific basis for an informed response.  American Association Nurse Anaesthesists J.. 1994;  62 537-543
    PubMedGoogle Scholar
  • 29 Lee J J, Rubin A P. Breast feeding and anesthesia.  Anaesthesia. 1993;  48 616-625
    PubMedGoogle Scholar
  • 30 Bond G M, Holloway A M. Anaesthesia and Breast-feeding - The Effect an Mother and Infant.  Anaesth. Intensive Care. 1992;  20 426-430
    PubMedGoogle Scholar
  • 31 Dailland P. Analgesia and anaesthesia and breastfeeding. In: Reynolds F (Editor) The Effects on the Baby of Maternal Analgesia and Anaesthesia. WB Saunders Company Ltd, London 1993: 251-270
    Google Scholar
  • 32 Madej T H, Strunin L. Comparison of epidural fentanyl with sufentanil. Analgesia and side effects after a single bolus dose during elective Caesarean section.  Anaesthesia. 1987;  42 1156-1161
    PubMedGoogle Scholar
  • 33 Kan R E, Hughes S C, Rosen M A, Kessin C, Preston P G, Lobo E P. Intravenous remifentanil: placental transfer, maternal and neonatal effects.  Anesthesiology. 1998;  88 (6) 1467-1474
    CrossrefPubMedGoogle Scholar
  • 34 von Peiker G, Müller B, Ihn W, Nöschel H. Ausscheidung von Pethidin durch die Muttermilch.  Zentralblatt Gynäkol.. 1980;  102 537-541
    PubMedGoogle Scholar
  • 35 Naumburg E G, Menry R G. Breast milk opioids and neonatal apnea.  Am. J. Dis. Child.. 1988;  142 11-12
    PubMedGoogle Scholar
  • 36 Jacobson B, Nyberg K, Grönbladh L, Eklund G, Bygdeman M, Rydberg U. Opiate addiction in adult offspring through possible imprinting after obstretic treatment.  Br. Med. J.. 1990;  301 1067-1070
    PubMedGoogle Scholar
  • 37 Kanto J. Risk-benefit assessment of anaesthetic agents in the puerperium.  Drug Safety. 1991;  6 285-301
    PubMedGoogle Scholar
  • 38 Coté C J, Kenepp N B, Reed S B, Strobel G E. Trace concentrations of halothane in human breast milk.  Br. J. Anaesth.. 1976;  48 541-543
    PubMedGoogle Scholar
  • 39 Berlin C M Jr, Yaffe S J, Ragni M. Disposition of acetaminophen in milk, saliva, and plasma of lactating woman.  Pediatr. Pharmacol.. 1980;  1 135-141
    PubMedGoogle Scholar
  • 40 Notarianni L J, Oldham H G, Bennett P N. Passage of paracetamol into breast milk and its subsequent metabolism by the neonate.  Br. J. Clin. Pharmacol.. 1987;  24 63-67
    PubMedGoogle Scholar
  • 41 Matheson I, Lunde P K, Notarianni L J. Infant rash caused by paracetamol in breast milk?.  Pediatrics.. 1985;  76 651-652
    PubMedGoogle Scholar
  • 42 Spielmann H, Steinhoff R, Schaefer C, Bunjes R. Arzneiverordnung in Schwangerschaft und Stillzeit. 5. Auflage, Gustav Fischer Verlag, Jena 1998
    Google Scholar
  • 43 Jamali F, Kesharvarz E. Salicylate in breast milk.  lnternational J. Pharmacol.. 1981;  8 285-290
    PubMedGoogle Scholar
  • 44 Unsworth J, d'Assis-Fonseca A, Beswick D T, Blake D R. Serum salicylate levels in a breast-fed infant.  Ann. Rheum. Dis.. 1987;  46 638-639
    PubMedGoogle Scholar
  • 45 Clark J H, Wilson W G. A 16-day old breast-fed infant with metabolic acidosis caused bei salicylate.  Clin. Pediatr. (Phila). 1981;  20 53-54
    PubMedGoogle Scholar
  • 46 Hurwitz E S, Barrett M J, Bregmann D, Gunn W J, Schonberger I B, Fairweather W R, Drage J S, La Montagne J R, Kaslow R A, Burlington D B, Quinnan G V, Parker R A, Phillips K, Pinsky P, Dayton D, Dowdl W R. Public Health Service study an Reye's syndrome and medications.  N. EngI. J. Med.. 1985;  313 849-857
    PubMedGoogle Scholar
  • 47 Townsend R J, Benedetti T J, Erickson S H, Cengiz C, Gillespie W R, Gschwend J, Albert K S. Excretion of ibuprofen into breast milk.  Am. J. Obstret. Gynecol.. 1984;  149 184-186
    PubMedGoogle Scholar
  • 48 Weibert R T, Townsend R J, Kaiser D G, Naylor A J. Lack of ibuprofen secretion into human milk.  Clin. Pharmacol.. 1983;  1 457-458
    PubMedGoogle Scholar
  • 49 Needs C J, Brooks P M. Antirheumatic medication during lactation.  Br. J. Rheumatol.. 1985;  24(3) 291-297
    PubMedGoogle Scholar
  • 50 Jamili F, Stevens D R. Naproxen in milk.  Drug Intell. Clin. Pharm.. 1983;  17 910-911
    PubMedGoogle Scholar
  • 51 Fidalgo I, Correa R, Gomez Carrasco J A, Martinez Quiroga F. Acute anemia, rectorrhagia and hematuria caused by ingestion of naproxen.  An. Esp. Pediatr.. 1989;  30 317-319
    PubMedGoogle Scholar
  • 52 Lebedevs T H, Wojnar-Horton R E, Yapp P, Roberts M J, Dusci L J, Hackett L P, Ilett K F. Excretion of indometacin in breast milk.  Br. J. Clin. Pharmacol.. 1991;  32 751-754
    PubMedGoogle Scholar
  • 53 Eeg-Olofsson O, Malmros I, Elwin C E, Steen B. Convulsions in a breast-fed infant after maternal indometacin.  Lancet. 1978;  22,2 (8082) 215
    PubMedGoogle Scholar
  • 54 Norton M E, Merrill J, Cooper B A, Kuller J A, Clyman R I. Neonatal complications after the admininistration of indomethacin for preterm labour.  N. Engl. J. Med.. 1993;  329 1602-1607
    CrossrefPubMedGoogle Scholar
  • 55 Zylber-Katz E, Linder N, Granit L, Levy M. Excretion of dipyrone metabolites in human breast milk.  Eur. J. Clin. Pharmacol.. 1986;  30 359-361
    CrossrefPubMedGoogle Scholar
  • 56 Rizzoni G, Furlanut M. Cyanotic crises in a breast-fed infant from mother taking dipyrone.  Hum. Toxicol.. 1984;  3 505-507
    PubMedGoogle Scholar
  • 57 Hagemann T M. Gastrointestinal medications and breastfeeding.  J. Hum. Lact.. 1998;  14(3) 259-262
    PubMedGoogle Scholar
  • 58 Hardell L I, Lindstrom B, Lonnerholm G, Osterman P O. Pyridostigmine in human breast milk.  Br. J. Clin. Pharmcol.. 1982;  14 565-567
    PubMedGoogle Scholar
  • 59 Kauppila A, Arvela P, Koivisto M, Kivinen S, Ylikorkola O, Pelkonen O. Metoclopramide and breast-feeding: transfer into milk and the newborn.  Eur. J. Clin. Pharmacol.. 1983;  25 819-823
    CrossrefPubMedGoogle Scholar
  • 60 Hofmeyr G J, van Iddekinge B. Domperidone and lactation. Lancet 1983 i: 47
    Google Scholar
  • 61 Okhubo T, Shimoyama R, Sugawara K. Measurement of haloperidol in human breast milk by high-performance liquid chromatography.  J. Pharmacol. Sci.. 1992;  81 947-949
    PubMedGoogle Scholar
  • 62 Lie B, Juul J. Effect of epidural vs. general anesthesia on breastfeeding.  Acta Obstet. Gynecol. Scand.. 1988;  67 207-209
    PubMedGoogle Scholar
  • 63 Hirose M, Hara Y, Hosokawa T, Tanaka Y. The effect of postoperative analgesia with continuous epidural bupivacaine after cesarean section on the amount of breast feeding and infant weight gain.  Anesth. Analg.. 1996;  82 1166-1169
    CrossrefPubMedGoogle Scholar
  • 64 Lebedevs T H, Wojnar-Horton R E, Yapp P, Roberts M J, Dusci L J, Hackett L P, Ilett K. Excretione of lignocaine and its metabolite monoethyl-glycinexylidide in breast milk following its use in a dental procedure. A case report.  J. Clin. Periodontol.. 1993;  20 606-608
    PubMedGoogle Scholar
  • 65 Zeisler J A, Gaarder T D, De Mesquitta S A. Lidocaine excretion in breast milk.  Drug Intell. Clin. Pharmacol.. 1986;  20 691-693
    PubMedGoogle Scholar
  • 66 Naulty J S, Ostheimer G, Datta S, Weiss J P. Bupivacaine in breast milk following epidural anesthesia for vaginal delivery.  Reg. Anesth.. 1983;  8 44-45
    PubMedGoogle Scholar
  • 67 Ortega D, Vivand X, Lorec A M, Gamerre M, Martin C, Bruguerolle B. Excretion of lidocaine and bupivacaine in breast milk following epidural anesthesia for cesarean delivery.  Acta Anaesthesiol. Scand.. 1999;  43(4) 394-397
    CrossrefPubMedGoogle Scholar
  • 68 Baker P A, Schroeder D. lnterpleural bupivacaine for postoperative pain during lactation.  Anesth. Analg.. 1989;  69 400-402
    PubMedGoogle Scholar
  • 69 Datta S, Camann W, Bader A, VanderBurgh L. Clinical effects and maternal and fetal plasma concentrations of epidural ropivacaine versus bupivacaine for cesarean section.  Anesthesiology. 1995;  82(6) 1346-1352
    PubMedGoogle Scholar

Dr. Peter Schneider

Klinik für Anaesthesiologie, op. Intensivmedizin, Schmerztherapie Klinikum Kreis Herford

Schwarzenmoorstraße 70 32049 Herford

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