# sedation for procedure and breastfeeding



## greatgazza (May 27, 2010)

Hi there

I'm not sure if this comes under your remit but I believe one of you, or perhaps both of you (i think there's only two of you on here? Holly and Mazv?) work in a hospital?

I'm due to have a colonoscopy next Friday and when I told them I was bfing they cancelled it due to the sedation.  When I called to say I really wanted the procedure as it is already overdue due to being pg last year (i have to have them five yearly) and asked for more detail as to how it would affect my bfing i was told that the sedation stays in the system for 5 hours.  i told them this was fine as that wouldn't be too long a time at all for my LO to have expressed milk.  however, i called the endoscopy unit again on friday to ask how long i would be there and the nurse was adamant the sedation stays in the system for 24 hours!! that would be a bit more difficult.  so i called the consultant's sec again on monday and told her what the nurse had said and she came back to say the dr said probably 8 to 12 hours would be safer!! now i'm very confused.  i don't have a problem with expressing and 'pumping and dumping' when i get full but i do want to know a definitive answer as to how long i need to wait so i can have enough milk expressed and don't feed him too soon if the sedative is still in my system.

there might be an option to have gas and air and pethidine but i think that might be quite uncomfortable for me? and the dr doing the procedure apparently prefers to use sedation.

just wondered if you might be able to help. or would you need to know what the actual meds are? i left another message for the secretary this afternoon asking what the actual sedation they use was but feel like she might be getting a bit fed up with me now!   (and she hasn't called me back yet...)  it's all been a bit of a kerfuffle so far and i really just want to know what i'm dealing with. 

thanks for any help you might be able to give me. also, is there anything i need to be aware of regarding the moviprep? they haven't mentioned anything to do with that with regard to bfing so i'm presuming i just carry on as normal?

GGx


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## Mistletoe (Holly) (Jan 1, 2007)

If it is midazolam, it can be tricky to know as it often depends on how much fat you have     

The half life varies from 1.8 hours to 6.6 hours.
So if we go with worse case scenario and you eliminate it slowly then you have to wait 5 half lives before it is completely gone - so 5x6.6 hours - 33 hours. But of course towards the end the amount would be minimal and even less in the milk, so 24 hours is probably about right, but could be less in a fast metaboliser.
It does depend on the dose how much is in the milk and also how much milk is consumed what the exposure is. 

I take is your infant is full term and healthy as this also has a bearing on decision.


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## greatgazza (May 27, 2010)

Hiya thanks for answering so quickly Holly.

Yes he was full term +5 (although quite small at birth, 6lbs 8 and it was originally twins) and he is pretty healthy and perky with no real issues to date.  Gosh, where did the dr get 5 hours from then??!! 

I'll call again tomorrow to find out if it's midazolam.  i don't suppose you'd have any idea whether gas and air and pethidine would be pretty uncomfortable/painful? 

how dangerous would it be for baby if he got some or would it just make him drowsy?

i wouldn't imagine i'm a particularly fast metaboliser but i really don't know... i'm 5 ft 7 and weighed 11 stone as of last week although i'm usually more around the 10/10 and a half stone mark. so pretty average  really and i think just in the right bmi range etc

this has already been a complete kerfuffle and i just really don't want to be told something different on the day and not have enough expressed milk for him etc.... i'm sure i'm probably worrying too much but i'd like to make the best provision for the situation i can

thanks

GGx


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## Mistletoe (Holly) (Jan 1, 2007)

Well my Dad recently had a flexisigmoidoscopy without any sedation at all and was fine, with just one bit where it was painful. He has dementia and I asked them to avoid sedation if possible.
Gas and air makes you not care about what is going on and is out of the system quickly.

As I said it would depend on the dose, which is probably quite low and the rate of metabolism. 5 hours would be about 3 half lives for a fast metaboliser, and if the dose is low enough then probably insignificant amounts in milk.

It would ake the baby drowsy if they got any midazolam.


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## greatgazza (May 27, 2010)

thank you so much.

that's really helpful.

i'll try and find out a bit more and if i do i'll let you know.

thanks again

GGc


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## greatgazza (May 27, 2010)

Hi Holly, 

just spoke to the nurse again who told me it was 24 hours and she said it is midazolam, up to 5mg, they can start you off with 3mg and then go up to 5 if you are still in pain.  She asked another doctor while we were on the phone and he said 24 hours too so i really don't know why the other doctor said 5 hours (and then changed it to 8 to12).  

i have asked if i could possibly have gas and air and maybe pethidine and see how i get on with the option of sedation if i can't tolerate it and i will prepare enough expressed milk to cope with the sedation.  Did your dad not even have gas and air or anything else?  I'm presuming the pethidine is totally safe, considering it's given in labour etc?

thanks again

GG xx


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## Mistletoe (Holly) (Jan 1, 2007)

Well I don't know, but I think he had nothing. He certainly seemed to remember it and said it was not too bad. He did not even have an IV cannula.

He said there was only a 10 second period when it was very painful, but the rest was fine.

Yes pethidine is used in labour and newborns can be drowsy due to it. It is excreted into breast milk.


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## greatgazza (May 27, 2010)

Thanks Holly.

Sorry, so, would you say that pethidine isn't really ok to have then?

GGx


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## Mistletoe (Holly) (Jan 1, 2007)

Well people do have it in labour and breast feed newborns. Your baby is older and if the dose is a one off and kept low the risk is less. The half life of the drug is 3.5 hours, but there is a metabolite that takes 24-48 hours for the concentration to drop by half. Pregnant women eliminate the drug more quickly.

You need to discuss with the doctor.


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## greatgazza (May 27, 2010)

Thanks Holly.


afraid i don't know what 'but there is a metabolite that takes 24-48 hours for the concentration to drop by half' means.

  yes i will discuss it with the doctor, it's just unfortunate that i've had such differing information to date and i really don't want a situation where i get there all 'prepped' (i.e. the day before's prep etc) for the procedure and then find they say i shouldn't have it if i'm worried about what they usually give etc....it's just a bit frustrating as i don't think i could have done more with phoning them and asking them so i really hope it can all go ahead and i'm happy about what they suggest

GGx


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## Mistletoe (Holly) (Jan 1, 2007)

Sorry hun - being too technical. I'll try and explain.
Basically pethidine is broken down in the liver to another drug that is also active (i.e. it can cause drowsiness and other side-effects) and this compound is then in turn got rid of. Although the pethidine disappears from the blood stream with the concentration dropping by half every 3.5 hours the compound that it is broken down into takes much longer to leave - the concentration dropping by half every 24-48 hours. We normally say 5 half lives for a drug to be out of the system.
So although the pethidine will be out of the system in 5x3.5 hours - or 17.5 hours, but the drug it is turned into could take 5-10 days to be completely undetectable.

The dose given is likely to be low though and a one off. The metabolite is much more of a problem after lots of doses are given over a few days.


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## greatgazza (May 27, 2010)

Hi Holly,

thanks for that.

I also spoke to someone at the breastfeeding network the other day after a friend recommended i speak to them and she was also a pharmacist who actually writes one of their guides 'colonoscopy and breastfeeding' and she said if i had midazolam i'd be fine to bf as soon as i wanted to, i.e. would be safe to do as soon as i came round!

anyhoo, i had the procedure today and the doc said (this is about the third doctor i'd spoken to by now i think) 24 hours or so for the midazolam as well and basically recommended just gas and air!  so i went with that and it was only painful a couple of times.  i explained to one of the senior sisters  how i'd got totally different and confusing advice and how difficult it had been and she admitted that they should perhaps write a policy on it  as i know other nhs trusts have them as pdfs that you can find on the internet.

wish i hadn't been so scared about just having gas and air or i would have just decided on that weeks ago.  altho i was quite looking forward to the sedation and a bit of a sleep in hosp as i'm still so knackered from broken nights!  

anyhoo, all's well that ends well and i got the all clear which was a huge relief so i'm off the hook for another five years.

thanks so much for all your answers

GGX


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## Mistletoe (Holly) (Jan 1, 2007)

Great news   

I had gas and air when I broke my ankle and it makes you feel weird and not caring. I just wanted to talk strange gibberish nonsense too - trouble is I knew I was talking nonsense but couldn't stop myself - very odd!

I also know what you mean about looking forward to an effortless sleep. That is one thing I enjoy about an anaesthetic if there is anything to be enjoyed.  A nice sleep in the middle of the day without any effort or disturbance!   I could do with a sleep now - I'm exhausted. 11 months of non stop being on duty 24/7 and I need a kip.


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## greatgazza (May 27, 2010)

Yep, know the feeling!

Yeah i kinda liked the gas and air but kept going to say rubbish and wasn't sure if it was rubbish or not, and also sounded like i'd sucked 70 helium balloons so felt really stupid when i talked so it put me off saying things that i thought were really funny but probably wouldn't have been   

hope you get some sleep tonight.  and me  

GGx


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