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The week we'll discuss some agents that are commonly used during anesthesia.for breast feeding women

1.Should the antiseptic agent povidone iodine be used in lactating mothers?
2.Should local anesthetics be avoided in breast feeding women?
3.Should opioids be avoided in breast feeding women?
1 消毒剂（聚维酮碘）能否用于哺乳期妇女?
2 哺乳期间是否应避免使用局麻药?
3 哺乳期间是否应避免使用阿片类药物?

参考答案（请战友指正）
1 消毒剂（聚维酮碘）能否用于哺乳期妇女?
在围产期妇女局部应用（聚维酮碘）后，可在乳汁中检测到碘。然而，只有在大量和多部位应用聚维酮碘后乳汁中碘浓度才会明显升高至引起婴儿甲状腺机能减退水平。有趣的是，由于碘与多聚携带物（碘载化合物）松散结合，此种碘载化合物不断释放碘，使得聚维酮碘局部应用后乳汁中碘水平高于其他以碘为基础的其他消毒剂。因此单次局部应用碘剂后，如用于局麻时消毒，风险性很小，但对于哺乳期妇女大量多次使用时应用其他替代品
2 哺乳期间是否应避免使用局麻药?
局麻药是否影响对婴儿的哺乳有很多的争议，已有研究表明，在生产分娩时应用局麻药和麻醉药后，乳汁中可检测到这些药物，但未发现这些药物对婴儿有负面效应得报道，因此一般认为局麻技术和局麻药（可卡因除外）应用于哺乳期妇女是安全的。不仅如此，局麻技术相对于全麻用药来说用药种类和剂量要少很多，局麻应用于这类患者可减少乳汁中药物的积聚，因此局麻更适合于哺乳期妇女
3 哺乳期间是否应避免使用阿片类药物?
多数阿片类药物治疗剂量下，乳汁中药物水平很低，对婴儿无负面效应。然而，一些阿片类药物在乳汁中分泌量较大，可影响新生儿的神经行为。剖宫产后应用度冷丁进行静脉自控镇痛与应用吗啡相比，婴儿的警觉能力和定向力较差。这可能是由于度冷丁的分解产物去甲哌替啶作用的结果，有研究指出去在乳汁中96小时仍可检测到甲哌替啶。比较而言，芬太尼400 µg用于哺乳妇女后，乳汁中未检测到芬太尼。
因此，婴儿食用了应用阿片类药物母亲的乳汁后表现出无症状呼吸暂停，心动过缓或紫绀，应该密切观察，应该暂停哺乳。

英文答案
1 Should the antiseptic agent povidone iodine be used in lactating mothers?
Topical use of povidone iodine in the peripartum period has been noted to produce detectable iodine levels in breast milk (1). However, significant levels, enough to cause infant hypothyroidism, were only produced when large and multiple applications of povidine iodine were used (2). Interestingly, these topical agents are associated with higher breast milk levels of iodine than iodine-based contrast mediums, as the iodine is loosely complexed with carrier polymers (called iodophores) which are formulated to release iodine (1). As such, although a single small application of topical iodine, as for a regional anesthetic procedure, can be used with minimal risk, alternatives should be used when large or repeated amounts are used in breast feeding women.
2 Should local anesthetics be avoided in breast feeding women?
Although there is some perceived controversy regarding the effects of local anesthetics on the ability of infants to breast feed, studies conducted with the use of epidural agents during labor and delivery have noted that although measurable levels of these local anesthetics and narcotics are obtained in breast milk, no adverse neonatal effects have been discovered (3). As such, it is generally accepted that regional anesthetic techniques and local anesthetic exposure (with exception of cocaine) is safe in breast feeding women. Moreover, regional anesthesia intuitively may be the most appropriate form of anesthesia for women wanting to minimize drug accumulation in breast milk, as traditionally, smaller amounts and fewer agents are utilized than with general anesthetic alternatives.
3 Should opioids be avoided in breast feeding women?
When given in therapeutic doses, most opioids appear in minute levels in breast milk and have not been associated with adverse neonatal effects (3). However, certain opioids are expressed to a greater extent in breast milk, and have been noted to produce neonatal neurobehavioral effects. Meperidine when given by intravenous patient controlled analgesia following cesarean delivery, has been associated with infants who were less alert and oriented than mothers exposed to morphine (4). In part, this is believed to result from its breakdown product, normeperidine, which has been noted to persist in breast milk for as long as 96 hours (4). By contrast, fentanyl has not been detected in breast milk when doses of up to 400 µg were used in lactating women (5).
Thus, although the majority of breast-feeding neonates of mothers taking opioids show no signs of apnea, bradycardia, or cyanosis, these symptoms should be watched for, and if present, breast feeding should be temporarily discontinued.