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Current recommendations suggest that women should breast-feed their infants until one year of life. However, many mothers may be required to take medications during this time. The week we'll discuss some anesthetic problem in relation to breast feeding

1 Are there agents which may be used during anesthesia whose effects on neonates and infants are unknown but may be of concern?
2 Are there anesthetic agents that should be avoided during breast feeding?
3 Are there some general guidelines regarding lactation following general anesthesia?

1 全麻药物中是否有些药物我们不知道其对对新生儿和婴儿产生影响，但在应用时应引起注意？
2 在哺乳期间是否有某些麻醉药物应该避免使用？
3 是否有一些指南指导全麻后的哺乳？

参考答案（请战友指正）               
1全麻药物中是否有些药物我们不知道其对对新生儿和婴儿产生影响，但在应用时应引起注意？
美国儿科学会已经规定精神性药物在长期应用于哺乳期母亲时应特别注意，精神性药物包括用于抗焦虑，抗抑郁，抗精神病等的药物，这些药物如下：
•抗焦虑药物：安定，劳拉西泮，咪唑安定，奋乃静，普拉西泮，夸西泮，替马西泮
•抗抑郁药物：阿米替林，阿莫沙平，地昔帕明，度硫平，多虑平，氟西汀，氟伏沙明，丙米嗪，曲唑酮
•抗精神病药物：氯丙嗪，氯普噻吨，氟哌啶醇，美索达嗪，氯霉素，甲氧氯普胺，双唑泰栓，替硝唑
曾经认为间断或单独应用这些药物对婴儿的危害很小，但如规律性使用，会导致药物及其代谢产物在婴儿体内蓄积。最近研究表明，哺乳期母亲服用这些药物后，会有少量药物的蓄积。Birnbaum等通过研究表明，在哺乳期应用抗抑郁药物和苯二氮唑类药物治疗产后抑郁症，婴儿血浆内未检测到这些药物。不仅如此，在孕期和哺乳期母亲是用这些药物后，尽管有26%的婴儿血浆中可检测到这些药物，但母亲均认为无困难存在。因此这些研究者认为，应用和选择这类药物时应该从母亲健康的角度出发，而不是从对胎儿或新生儿影响的角度出发。
2 在哺乳期间是否应该避免应用麻醉药物？
只有很少的药物应在哺乳期予以避免。其中有一种麻醉药物是可卡因。可卡因有时局部用于鼻粘膜促进血管收缩和局麻，曾经认为其对婴儿有毒性作用，而建议使用其他药物替代。
3 是否有一些指南指导全麻后的哺乳？
大多数研究者认为，母亲全麻对哺乳期婴儿的影响很小，可以忽略。然而，由于对很多药物的认识来源于回顾性研究和个案的报道，麻醉医生应该尽可能应用有悠久历史的药物，并且尽可能减少药物的总量。由于此方面的知识需要更多的研究和报道不断进行更新，因此麻醉医生应该不断去检索新的证据（如美国儿科学会的资源）。不仅如此，患者应特别引起注意，麻醉药物浓度在麻醉后乳汁中会很快升高，乳汁可能在麻醉前分泌，一直储存至术后于哺乳时。因此麻醉后乳汁应该排除并遗弃。

英文参考答案：

1 Are there agents which may be used during anesthesia whose effects on neonates and infants are unknown but may be of concern?
The American Academy of Pediatrics has stated that psychotropic drugs, (defined as the compounds used for their antianxiety, antidepressant, and antipsychotic principles), are of special concern when given to nursing mothers for long periods (1). The agents they list are:
•Antianxiety: Diazepam, Lorazepam, Midazolam, Perphenazine, Prazepam*,Quazepam, Temazepam
•Antidepressants: Amitriptyline, Amoxapine, Desipramine, Dothiepin, Doxepin, Fluoxetine, Fluvoxamine, Imipramine, Trazodone
•Antipsychotic: Chlorpromazine,Chlorprothixene, Haloperidol, Mesoridazine, Chloramphenicol, Metoclopramide*, Metronidazole, Tinidazole.
Intermittent or single use of these agents has been suggested to pose little risk to infants, however, regular use may result in accumulation of the drug and its metabolites in infants. Recent work confirms that minimal, if any, accumulation of these agents occurs in mothers taking these agents during breast feeding. Birnbaum et al (2), in evaluating antidepressants and benzodiazepines used therapeutically for postpartum depression during breast feeding, was unable to demonstrate serum levels of these agents in the infants plasma. Moreover, when infants were exposed to these agents during pregnancy and during breast feeding, although plasma levels could be detected in 26% of the infants, no difficulties were reported by their mothers. As such, these authors concluded that the selection and use of these classes of drugs should be determined by maternal well being, rather than potential fetal and neonatal effects.
2 Are there anesthetic agents that should be avoided during breast feeding?
There are a limited number of agents that should be avoided (3). One agent on this list that has been used in the anesthetic setting is cocaine. Sometimes used a topical agent to promote vasoconstriction of the nasal epithelium and provide local anesthesia, cocaine has been noted to cause intoxication in infants as well, and other alternatives should be used (3).
3 Are there some general guidelines regarding lactation following general anesthesia?
Most investigators agree that maternal exposure to general anesthesia has negligible effects on nursing neonates (4, 5). However, as the knowledge regarding many agents is limited to retrospective or single case reports, anesthetic providers should be encouraged to use agents that have a long history of use, and limit the overall amount of medications when possible. As the information on this topic is subject to change with further studies and reports, providers are encouraged to check various resources (such as the American Academy of Pediatrics ) should questions arise. Moreover, as levels of anesthetic agents would be expected to the highest in breast milk immediately following the procedure, should great concern be demonstrated by the patient, breast milk may be pumped prior to the procedure and saved for the postoperative feeding time. In addition, breast milk immediately post-procedure may be pumped and discarded.