Propofol is a commonly used intravenous anesthetic, and breastfeeding parents often have questions about its safety for their infants. This article provides information on propofol and offers practical guidance for breastfeeding parents.
Understanding Propofol
Propofol is a rapid-acting intravenous anesthetic used for inducing and maintaining general anesthesia, and for sedation during various medical procedures. It works by enhancing the activity of gamma-aminobutyric acid (GABA), a neurotransmitter in the brain that slows down brain activity. This action leads to a quick onset of unconsciousness, typically within 15 to 30 seconds after administration.
The effects of a single dose of propofol are short-lived, usually lasting about 5 to 10 minutes, due to its rapid distribution throughout the body and efficient metabolism. It is highly lipid-soluble and is metabolized primarily in the liver into inactive compounds, which are then excreted from the body. This swift clearance from the body is a significant factor when considering its use in breastfeeding individuals.
Propofol Transfer into Breast Milk and Infant Safety
Propofol transfers into breast milk, but in very small amounts not expected to be significantly absorbed by the infant. Studies indicate less than 0.1% of the administered dose appears in breast milk within 24 hours. This minimal transfer is due to propofol’s pharmacological properties.
Propofol is highly lipid-soluble, allowing it to diffuse into the lipid portion of breast milk. It also has a high protein-binding capacity, meaning a large portion of the drug in the mother’s bloodstream is bound to proteins and less available for transfer into milk. Its rapid metabolism in the liver into inactive, water-soluble metabolites further reduces the active drug in the mother’s system and milk. The estimated infant dose from breast milk after a single maternal dose is approximately 0.2% of the weight-adjusted maternal dosage, considered unlikely to affect a healthy, full-term infant.
Practical Guidance for Breastfeeding Parents
Breastfeeding can be resumed as soon as the mother has recovered sufficiently from general anesthesia to nurse, meaning when the parent is awake, alert, and able to safely hold their infant. There is generally no need to express and discard breast milk, or “pump and dump,” after receiving propofol. This outdated advice was given before comprehensive data on drug accumulation in breast milk was widely available.
If a combination of anesthetic agents was used, follow recommendations for the medication with the longest duration of action or highest risk. While significant adverse effects in breastfed infants are rare, observe the infant for any subtle signs of drowsiness, increased sleepiness, or changes in breathing patterns. These observations are particularly important for premature infants or those with a history of apnea.
Communicate with healthcare providers, including the anesthesiologist, before a procedure to discuss concerns and receive personalized guidance. They can help time feeds and pumping sessions to optimize milk supply and infant safety. Expressing and storing milk before the procedure can be helpful for longer operations or if the parent and infant might be separated.