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Response to S ilvani and C amporesi, regarding their comment on our paper safety of the breast‐feeding infant after maternal anesthesia
Author(s) -
Dalal Priti G.,
Berlin Cheston
Publication year - 2014
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/pan.12376
Subject(s) - medicine , anesthesiology , medical school , pediatrics , medical education , anesthesia
SIR—We read with great interest the review by Dalal et al. (1), regarding the safety of breast-feeding after maternal anesthesia. This article represents a very useful guide for any anesthesiologist in the management of nursing mothers. However, in our opinion, the neurotoxicity of anesthetics, passed through breast milk, is completely omitted by the authors. In recent years, several articles formulated concerns regarding anesthesia and neurotoxicity in the developing brain (2). Particularly, midazolam, given s.c., at sedation (subanesthetic) levels, caused significant apoptotic degeneration in infant mice (3). Although the data regarding neurodevelopmental toxicity of these agents in humans, especially at these doses and duration of exposure, remain controversial and somewhat speculative, the risk of giving midazolam to a nursing mother cannot be considered only in terms of infant sedation. As the authors correctly stated, low milk/plasma ratio and oral bioavailability, in addition to short half-life, make midazolam an ideal sedative in terms of neonatal neurologic depression. The same security cannot be invoked in terms of prevention of neurotoxicity. In this context, the use of any unessential (such as premedication sedatives) and potentially harmful drug must be considered with great caution.