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Ketamine use while Breastfeeding

Drugs containing Ketamine: Ketalar, LidoProfen

Ketamine Levels and Effects while Breastfeeding

Summary of Use during Lactation

Breastmilk levels of ketamine have not been measured after administration to humans. Minimal data indicated that ketamine use in nursing mothers may not affect the breastfed infant or lactation. Until more data are available, ketamine should only be used with careful monitoring during breastfeeding.

Drug Levels

Maternal Levels. Relevant published information was not found as of the revision date.

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

Four mothers who received epidural analgesia with lidocaine and bupivacaine for cesarean section also received general anesthesia with ketamine and midazolam (dosages not specified). Their infants were either breastfed or received their mother's breastmilk by bottle. No adverse effects were reported in the infants.[1]

Effects on Lactation and Breastmilk

A pregnant woman sustained 28% body surface area burns near term. She underwent an emergency cesarean section on her due date under ketamine anesthesia. Although the infant required vigorous resuscitation, the infant began breastfeeding immediately. The infant had transient jaundice that resolved in a few days.[2]

A study compared women undergoing cesarean section who received either placebo or S-ketamine 0.5 mg/kg intramuscularly, followed by a continuous infusion of 2 mcg/kg/minute for 12 hours. This low dose was used to enhance analgesia and reduce residual pain rather than to provide anesthesia. All women received intraspinal bupivacaine 8 to10 mg and sufentanil 5 mcg for analgesia, as well as midazolam 0.02 mg/kg intravenously before the S-ketamine or placebo injection. Postoperatively, patients received patient-controlled intravenous morphine for 24 hours, followed by acetaminophen, oral ketorolac and a single dose of ondansetron 8 mg intravenously as needed. Of the 56 patients enrolled in the study (28 in each group), 13 in each group were contacted at 3 years postpartum. Patients who received placebo reported breastfeeding for an average of 10.5 months and those who received S-ketamine reported breastfeeding for an average of 8 months; however, the difference was not statistically significant.[3]

Alternate Drugs to Consider

Methohexital, Propofol, Thiopental

References

1. Ortega D, Viviand X, Lorec AM et al. Excretion of lidocaine and bupivacaine in breast milk following epidural anesthesia for cesarean delivery. Acta Anaesthesiol Scand. 1999;43:394-7. PMID: 10225071

2. Mokube JA, Verla VS, Mbome VN, Bitang AT. Burns in pregnancy: a case report from Buea Regional Hospital, Cameroon. Pan Afr Med J. 2009;3:2. PMID: 21532730

3. Suppa E, Valente A, Catarci S et al. A study of low-dose S-ketamine infusion as "preventive" pain treatment for cesarean section with spinal anesthesia: benefits and side effects. Minerva Anestesiol. 2012;78:774-81. PMID: 22374377

Ketamine Identification

Substance Name

Ketamine

CAS Registry Number

6740-88-1

Drug Class

Anesthetics, Intravenous

Hypnotics and Sedatives

Administrative Information

LactMed Record Number

1004

Last Revision Date

20160401

Disclaimer

Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.

Disclaimer: This information is not intended as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. Use of this website signifies your agreement to the Terms of Use and Online Privacy Policy.

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