Perianesthetic Considerations for the Breastfeeding Mother

Using a Cognitive Aid to Improve Confidence in Counseling Regarding Current Anesthesia-Related Breastfeeding Recommendations

PURPOSE

Although most anesthetic drugs are classified as compatible with breastfeeding, literature shows that anesthesia providers routinely advise patients to discard milk when receiving all types of anesthesia. The purpose of this project was to determine if a multimodal educational module and cognitive aid improved student registered nurse anesthetists' knowledge and confidence to counsel lactating patients on current anesthesia-related recommendations.

DESIGN

This project used a pre-experimental one-group, pretest and post-test design.

METHODS

Preintervention and postintervention surveys measured knowledge and confidence to counsel lactating patients scheduled to receive anesthesia.

FINDINGS

Significant improvement in knowledge and confidence after the intervention were noted.

CONCLUSIONS

A multimodal educational session and cognitive aid improved student registered nurse anesthetists' knowledge about current anesthesia-related breastfeeding recommendations and their confidence in counseling these patients. Wider use of this educational module with the cognitive aid has the potential to positively impact breastfeeding patients and their children.

Best Practices for the Care of Breastfeeding Patients Requiring Local or General Anesthesia

The care of breastfeeding patients who require anesthesia presents unique challenges; therefore, caregivers must be knowledgeable regarding drugs' pharmacodynamic and pharmacokinetic profiles to ensure the safety of the breastfed infant. Although most anesthetic drugs are compatible with breastfeeding, health care providers continue to advise patients to "pump and dump." This advice can lead to undesirable outcomes, including interruption or cessation of breastfeeding, creating possible physical and psychological challenges for parents and their neonates. This article outlines best practices for the care of breastfeeding patients receiving anesthesia.

Health Care Providers' Perspective and Knowledge about Peri-Surgical Medication and Practices in Breastfeeding Women

Many guidelines offer recommendations to support the continuation of breastfeeding and the choice of medication when a mother undergoes a surgical procedure. The aim of this study is to investigate health care providers' (HCPs) current practices and knowledge about peri-surgical medication and practices in breastfeeding women. We performed a cross-sectional study in Flanders (Belgium) assessing demographics, beliefs about breastfeeding and its health benefits, current practices concerning breastfeeding women undergoing (surgical) procedures and specific knowledge about the use of medication during breastfeeding. Two hundred and ninety-one (291) participants completed the online questionnaire. Many participants considered their knowledge about breastfeeding to be good, and almost all participants acknowledged the superiority of breastfeeding and the importance of its continuation. Very few participants were, however, familiar with the available protocols concerning surgical procedures in breastfeeding women. Less than half of the participants routinely advised the recommended practices to protect breastfeeding. For most of the peri-surgical medication, participants needed to look-up information about the compatibility with breastfeeding. We conclude that there is a knowledge gap and recommend the development of a comprehensive guideline as well as implementation of this information in basic and post-academic training.

Supporting Lactation in Otolaryngology Patients Through Medication Optimization, Radiology Considerations, and More: A Literature Review

Importance

The benefits of breastfeeding are well established, with the American Academy of Pediatrics and Canadian guidelines recommending exclusive breastfeeding for the first 6 months of life. However, maternal hospitalization, illness, medication use, and poor support can result in early termination of breastfeeding. Caring for breastfeeding patients in otolaryngology is a challenge because of the lack of literature regarding otolaryngology-specific medication safety, patient concerns, and inadequate education among otolaryngologists. This review highlights recent literature regarding lactation in otolaryngology patients, including medication, radiologic imaging, perioperative considerations, and subspecialty-specific considerations for lactating patients.

Observations

The majority of common medications used in general otolaryngology are safe for breastfeeding patients, including antihistamines, mucolytics, antitussives, antifungals, and decongestants. Certain analgesics and anti-inflammatories, such as tramadol, are not preferred in breastfeeding individuals. Some subspeciality-specific medications such as biologics (dupilumab) and methotrexate should be avoided. Lactating patients require special perioperative attention to ensure that optimal patient care is provided, such as managing supply, considering length of surgery, managing postoperative pain, and determining the safe amount of time until an infant can be fed.

Conclusions and Relevance

Most medications can be safely used with lactating patients. If physicians are unsure about a medication's safety, they should consult appropriate resources prior to recommending breastfeeding cessation or to discard pumped milk.

Acute Maternal Fasting or Fluid Abstention Does Not Significantly Affect the Macronutrient Composition of Human Milk: Clinical and Clinical Research Relevance

There are guidelines on lactation following maternal analgo-sedative exposure, but these do not consider the effect of maternal fasting or fluid abstention on human milk macronutrient composition. We therefore performed a structured search (PubMed) on ‘human milk composition’ and screened title, abstract and full paper on ‘fasting’ or ‘abstention’ and ‘macronutrient composition’ (lactose, protein, fat, solids, triglycerides, cholesterol). This resulted in six papers and one abstract related to religious fasting (n = 129 women) and observational studies in lactating women (n = 23, healthy volunteers, fasting). These data reflect two different ‘fasting’ patterns: an acute (18–25 h) model in 71 (healthy volunteers, Yom Kippur/Ninth of Av) women and a chronic repetitive fasting (Ramadan) model in 81 women. Changes were most related to electrolytes and were moderate and mainly in the chronic repetitive fasting model, with no clinical significant changes in macronutrients during acute fasting. We therefore conclude that neither short-term fasting nor fluid abstention (18–25 h) affect human milk macronutrient composition, so that women can be reassured when this topic was raised during consulting. Besides the nutritional relevance, this also matters, as clinical research samples—especially estimating analgo-sedative exposure by lactation—are commonly collected after maternal procedural sedation and maternal fasting. Based on these results, it is reasonable to assume stable human milk composition when such data are used in physiology-based pharmacokinetic (PBPK) models.