AMEHigh

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I’m not in anesthesia.
I do outpatient procedures. The procedures last 5-7 minutes. Patients either get "light" anesthesia with IV benzo and IV opioid or "deep" sedation with propofol.

Today the nurse ran in and asked anesthesia about the patient who was breastfeeding and if they needed to pump and dump. He said yes for at least 24 hours.

I thought that was "old school" and patients didn’t need to do that anymore as there is no evidence it’s necessary for this kind of anesthesia. I was going to say something and will look it up more later at the end of the day, but was wondering about what you all do and the research.
 
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dipriMAN

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No need to pump and dump with prop and short acting opioids. I typically don’t really give midaz, but maybe pump and dump out of an abundance of caution from the midaz.

yes, the old school advice was one day before breastfeeding.
 
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dipriMAN

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if I remember correctly there is no actual evidence either way to prove safety of continuing breastfeeding. If anyone asks me I usually tell them this, tell them it’s a risk benefit, if they’re worried than pump and dump, but highly likely that it’s safe to continue.
 
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Southpaw

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No pump and dump, especially for what you’re doing. Sometimes moms look at me weird when I say that so I leave it up to whatever they’re comfortable with.
 
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SaltyDog

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Our lactation consultants are now telling patients that if they are awake it’s ok to breastfeed.
 
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Our lactation consultants are now telling patients that if they are awake it’s ok to breastfeed.

It's amazing that lactation consultant is a thing

although i guess physical therapists are ambulation consultants
and dentists are mastication consultants
 

Volatile

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There is no longer a need to pump and dump. Patients can breastfeed after GA, dilaudid ect. As long as the patient is awake, they can begin breastfeeding as soon as they hit the pacu. This was the policy where I trained (large academic hospital), and at my current hospital.
 
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AMEHigh

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I'm not anesthesia either


Sorry if I offended.
The person doing anesthesia today is a crna, wasn’t sure the correct term to use, but didn’t want to say anesthesiologist. I guess I could’ve just said crna! But I was just typing quickly in between patients.

Thank you all for confirming what I thought is true.

Next time I’ll speak up because for some patients it is distressing and a big decision to not breast feed for 24 h (might not have formula on hand, might not be good at pumping/have supplies) and I don’t think some people realize that. I guess since I talk with patients in an outpatient setting I think about those things more.

Thanks for the help!
 
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Urzuz

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Sorry if I offended.
The person doing anesthesia today is a crna, wasn’t sure the correct term to use, but didn’t want to say anesthesiologist. I guess I could’ve just said crna! But I was just typing quickly in between patients.

Thank you all for confirming what I thought is true.

Next time I’ll speak up because for some patients it is distressing and a big decision to not breast feed for 24 h (might not have formula on hand, might not be good at pumping/have supplies) and I don’t think some people realize that. I guess since I talk with patients in an outpatient setting I think about those things more.

Thanks for the help!

In case anyone tries to cite old evidence/recommendations to you:

 
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SaltyDog

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It's amazing that lactation consultant is a thing

although i guess physical therapists are ambulation consultants
and dentists are mastication consultants

And we’re just hibernation consultants.
 
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AMEHigh

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do you guys call gastroenterologists - "colonoscope"?

No, I said apologizes above.
I should’ve said crna so people didn’t think I was talking about an anesthesiologist. If it were an anesthesiologist I would’ve used that word instead.
 

Twiggidy

Manny Rivers Cuomo
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Jan 13, 2015
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I’m not in anesthesia.
I do outpatient procedures. The procedures last 5-7 minutes. Patients either get "light" anesthesia with IV benzo and IV opioid or "deep" sedation with propofol.

Today the nurse ran in and asked anesthesia about the patient who was breastfeeding and if they needed to pump and dump. He said yes for at least 24 hours.

I thought that was "old school" and patients didn’t need to do that anymore as there is no evidence it’s necessary for this kind of anesthesia. I was going to say something and will look it up more later at the end of the day, but was wondering about what you all do and the research.
These patients come around quite often, especially when practicing in an area with a lot of young couples starting families. I explain to them that every drug I plan to use is short acting and should be out of their system when they’re on their way home. I leave it up to them if they want to pump and dump for 24 hrs but emphasize that they can definitely breastfeed that night without worry, just in case they want to dump maybe the next two, but also emphasize they can safely breastfeed no different than if you were to get a GA for childbirth (I use less scary words)

And that’s really the rationale. We do GA for childbirth (C-sections) often and the mothers breastfeed when they’re awake. It’s no different
 
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AMEHigh

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Thanks all for the help, appreciate it!
I’m kind of kicking myself for not saying anything today.
But I reviewed the resources you all posted and will be prepared for next time.
And now that I think about it next time I’m doing cases there I should educate the nurses anyway, so they’re knowledgeable as well.
 

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