Medications and anesthetics used during surgery

[Soserbee]

I am having surgery next week to change my pacemaker battery. I have a three month old who I am exclusively breastfeeding approxImately 8-10/day. During surgery, I will be given 1-2 doses of Ancef through IV. They will use either zylocaine or lidocaine as an oral anesthetic at the point of incision. They will use either Propofal, Neuroleptic or Midazolam (or a combination) as a sedative. They have also proposed the use of an antibacterial mesh that is placed around the pacemaker. The mesh contains Minocycline 102ug/cm2 and Rifampin 102ug/cm2. The mesh is 2.9"x3.3" in size. The mesh will be absorbed in two to three weeks. It is optional. I would like to know the impact of each of these meds on breastfeeding, both individually and together, and how long it would be recommended not to breastfeed post surgery.

[admin]

Soserbee,

Ancef is rated an L1-limited data-probably compatible. The amount transferred into breast milk is only 0.8% of your dose. Monitor your infant for vomiting, diarrhea and rash.

Lidocaine (xylocaine) is rated an L2-limited data-probably compatible. The amount transferred into breast milk is 0.5-3.1% of your dose. The only time we would tell you to wait any length of time to breastfeed with this medication is if it was injected directly onto the breast.

Propofol is rated an L2-limited data-probably compatible. The amount transferred is 4.4% of your dose. Wait 4 hours after your procedure to breastfeed provided you are fully awake and your infant does not have a history of apnea. Monitor for sedation, slowed breathing rate, not waking to feed/poor feeding and apnea.

Midazolam (Versed) is rated an L2-limited data-probably compatible. The amount transferred is 0.004-0.6% of your dose. Wait 4 hours after this medication also to breastfeed. Monitor for sedation, slowed breathing rate, not waking to feed/poor feeding and apnea.

The amount of minocycline and rifampin in the antibacterial envelope is very small. According to the TYRX brand of antibacterial envelopes a medium size envelope contains 8.0mg of rifampin and 5.1mg of minocycline, the large envelope contains 11.9mg of rifampin and 7.6mg of minocycline. A normal adult dose of rifampin is 600mg a day, and minocycline is a 100mg twice a day, so the doses in the envelope would be extremely small and should be ok to breastfeed with.

Sandra Lovato R.N.
Infant Risk Center
806-352-2519

[Soserbee]

Thank you. The lidocaine will be injected around the incision between my left collar bone and breast. What proximity to the breast would determine waiting any length of time? What would the time frame be?

[admin]

Soserbee,

The concern with lidocaine directly into the breast is if it were to be accidentally injected directly into a milk duct, the placement of your pacemaker should be too high to get into the milk ducts. If the injection was in the breast itself we would recommend waiting until all numbness and tingling were gone out of that breast then wait another 6-8 hours after that to breastfeed again from the affected side, but can continue to breastfeed from unaffected side.

Sandra Lovato