Ketamine

Drug Levels and Effects:




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 andbupivacainefor 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]


Possible Effects on Lactation:


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 intraspinalbupivacaine8 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 and oral ketorolac 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 10.5 months. 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 andbupivacainein 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



Substance 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:


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