Last update Jan. 8, 2024

Sevoflurane

Compatible

Safe product and/or breastfeeding is the best option.

Volatile halogenated anesthetic administered by inhalation.

Since the last update we have not found published data on its excretion in breast milk.

95% is excreted via the lung without having been metabolized. Several authors believe that the amount excreted in milk is minimal, therefore it is considered safe during breastfeeding (Dalal 2014, Hale 1999, Spigset 1994), as well as another anesthetic from the same family, halothane, which is considered compatible with breastfeeding by the American Academy of Pediatrics.

The residual amount of fluoride that is produced is minimal and is chelated by the calcium in the milk.

Given its rapid elimination from the body and that the drug is not expected to be absorbed by the infant, it is possible to breastfeed as soon as the mother has recovered from the anesthesia.

Breastfeeding before anesthesia reduces the need for sevoflurane and also propofol to maintain the anesthesia. (Bhaskara 2016)

General anesthesia in caesarean sections delays the start of breastfeeding with respect to epidural anesthesia. (Kutlucan 2014)

OCCUPATIONAL EXPOSURE. Operating room personnel and other areas where volatile anesthetics such as sevoflurane are routinely used (Schiewe 2005):

Professionals working in the operating room may inhale volatile anesthetics that may appear in milk of nursing mothers (Cote 1976), but in clinically insignificant quantity, so breastfeeding is not contraindicated.

No toxic effects from chronic exposure to sevoflurane have been found. (MSC 2001)

The Spanish National Institute for Safety and Health at Work (INSSTE 2022) and other international agencies do not state what the Occupational Limit Value - Daily Exposure for sevoflurane is (Herzog 2018). Sweden sets an ED-LELV of 10 ppm. (INSHT 2012)

The US National Institute for Occupational Safety and Health (NIOSH) established a recommended occupational exposure limit (REL) of 2 ppm for sevoflurane and other volatile anaesthetics. (Alonso MM 2022).

Workplace monitoring of sevoflurane concentration must be ensured with adequate exhaust gas extraction systems together with ventilation systems that produce a sufficient number of air changes of at least 10 air exchanges per hour (INSHT 2010). The minimum flow rate of outside air to be supplied should be 1,200 m3/h, to keep the concentration of anaesthetic and disinfectant gases within an acceptable ambient level (≤ 0.4 ppm) in class I rooms, such as operating rooms. (INSHT 2010)

The real risk is in places close to operating rooms where there is no adequate extraction and ventilation system, such as some intensive care units or recovery rooms. (Byhahn 2001 and 1999)


See below the information of this related product:

  • Halothane (Safe product and/or breastfeeding is the best option.)

Alternatives

We do not have alternatives for Sevoflurane since it is relatively safe.

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Sevoflurane in other languages or writings:

Group

Sevoflurane belongs to this group or family:

Tradenames

Main tradenames from several countries containing Sevoflurane in its composition:

Pharmacokinetics

Variable Value Unit
Molecular weight 200 daltons
VD 0.5 l/Kg
1.8 - 3.8 hours

References

  1. Alonso Prieto MM. Exposición laboral a residuos ambientales de sevoflurano durante exploraciones de resonancia magnética en pacientes pediátricos. Tesis Doctoral- Universidad Autónoma de Madrid 2022 Full text (link to original source)
  2. Herzog-Niescery J, Seipp HM, Weber TP, Bellgardt M. Inhaled anesthetic agent sedation in the ICU and trace gas concentrations: a review. J Clin Monit Comput. 2018 Aug;32(4):667-675. Abstract
  3. Bhaskara B, Dayananda VP, Kannan S, Raghavendra Rao RS, Ramachandraiah R. Effect of breastfeeding on haemodynamics and consumption of propofol and sevoflurane: A state entropy guided comparative study. Indian J Anaesth. 2016 Abstract
  4. Dalal PG, Bosak J, Berlin C. Safety of the breast-feeding infant after maternal anesthesia. Paediatr Anaesth. 2014 Abstract
  5. Kutlucan L, Seker İS, Demiraran Y, Ersoy Ö, Karagöz İ, Sezen G, Köse SA. Effects of different anesthesia protocols on lactation in the postpartum period. J Turk Ger Gynecol Assoc. 2014 Dec 1;15(4):233-8. Abstract Full text (link to original source)
  6. INSHT-Instituto Nacional de Seguridad e Higiene en el Trabajo. Gases anestésicos en ámbitos no quirúrgicos (I): sistemas de aplicación. Notas Técnicas de Prevención. 2012 Full text (link to original source) Full text (in our servers)
  7. INSHT-Instituto Nacional de Seguridad e Higiene en el Trabajo. Ventilación general en hospitales. Notas Técnicas de Prevención. 2010 Full text (link to original source) Full text (in our servers)
  8. Schiewe-Langgartner F, Wiesner G, Gruber M, Hobbhahn J. [Exposure of hospital personnel to sevoflurane]. Anaesthesist. 2005 Jul;54(7):667-72. German. Abstract
  9. MSC-Ministerio de Sanidad y consumo. España. Agentes anestésicos inhalatorios. Protocolos de vigilancia específica. 2001 Full text (link to original source) Full text (in our servers)
  10. Byhahn C, Wilke HJ, Westpphal K. Occupational exposure to volatile anaesthetics: epidemiology and approaches to reducing the problem. CNS Drugs. 2001;15(3):197-215. Review. Abstract
  11. Byhahn C, Lischke V, Westphal K. [Occupational exposure in the hospital to laughing gas and the new inhalation anesthetics desflurane and sevoflurane]. Dtsch Med Wochenschr. 1999 Feb 12;124(6):137-41. German. Abstract
  12. Hale TW. Anesthetic medications in breastfeeding mothers. J Hum Lact. 1999 Sep;15(3):185-94. Review. No abstract available. Abstract
  13. Spigset O. Anaesthetic agents and excretion in breast milk. Acta Anaesthesiol Scand. 1994 Abstract
  14. Lee JJ, Rubin AP. Breast feeding and anaesthesia. Anaesthesia. 1993 Jul;48(7):616-25. Review. Abstract Full text (link to original source) Full text (in our servers)
  15. Coté CJ, Kenepp NB, Reed SB, Strobel GE. Trace concentrations of halothane in human breast milk. Br J Anaesth. 1976 Abstract Full text (link to original source) Full text (in our servers)

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