Sevoflurane

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.)