毒理性
◉ 母乳喂养期间使用总结:有限的数据表明,dexmedetomidine(右美托咪定)在静脉输注结束后4到6小时内会以非常小的量排入母乳中。药物在输注结束后24小时内在母乳中检测不到。预计舌下使用后排入乳汁中的量会少于静脉输注。由于乳汁中剂量低且口服生物利用度差,dexmedetomidine不会预期对哺乳的婴儿或新生儿造成不良影响。在舌下使用期间,监测哺乳婴儿是否出现烦躁不安。
◉ 对哺乳婴儿的影响:截至修订日期,没有找到相关的已发布信息。
◉ 对泌乳和母乳的影响:在一项双盲研究中,将160名在脊髓麻醉下接受选择性剖宫产的妇女随机分配到接受患者控制静脉镇痛的舒芬太尼(标准治疗)或标准治疗加dexmedetomidine。dexmedetomidine的剂量为5微克/千克,随后以0.5微克/千克/小时的速度持续输注至手术结束。后一组患者在术后2天内接受dexmedetomidine加舒芬太尼的患者控制静脉镇痛。接受dexmedetomidine的患者第一次泌乳的时间更短(28小时对34小时),更快实现纯母乳喂养(8天对11天),并且在产后第二天有更多的乳汁。
在另一项回顾性研究中,比较了接受剖宫产的三种方案:麻醉前和分娩期间使用dexmedetomidine(n = 115),麻醉前和分娩期间使用生理盐水,分娩后使用dexmedetomidine(n = 109),以及麻醉前和分娩期间使用生理盐水(n = 168)。与其它组相比,麻醉前和分娩期间接受dexmedetomidine的妇女在医院期间消耗的舒芬太尼和昂丹司琼更少,并且第一次产生乳汁的时间略短(25分钟对27至28分钟)。
◉ Summary of Use during Lactation:Limited data indicate that very small amounts of dexmedetomidine are excreted into breastmilk for 4 to 6 hours after the end of an intravenous infusion. The drug is absent from breastmilk by 24 hours after the end of an infusion. The amounts in milk after sublingual use are expected to be less than after intravenous infusion. Because of the low dose in milk and its poor oral bioavailability, dexmedetomidine would not be expected to cause adverse effects in breastfed infants or neonates. Monitor the breastfed infant for irritability during sublingual use.
◉ Effects in Breastfed Infants:Relevant published information was not found as of the revision date.
◉ Effects on Lactation and Breastmilk:A double-blind study randomized 160 women receiving an elective cesarean section under spinal anesthesia to receive either sufentanil for patient-controlled intravenous analgesia (standard care) or standard care plus dexmedetomidine. Dexmedetomidine was given as 5 mcg/kg, followed by a continuous infusion of 0.5 mcg/kg per hour until the end of surgery. Patient in this latter group received dexmedetomidine plus sufentanil for patient-controlled intravenous analgesia postoperatively for 2 days. Patients who received dexmedetomidine had a shorter time to the first lactation (28 vs 34 hours), achieved exclusive breastfeeding sooner (8 vs 11 days) and had a greater amount of milk on the second day postpartum.
In a retrospective study of women undergoing cesarean section deliveries, 3 regimens were compared: dexmedetomidine before anesthesia and during delivery (n = 115), normal saline before anesthesia and during delivery and dexmedetomidine after delivery (n = 109), and normal saline before anesthesia and during delivery (n = 168). Women who received dexmedetomidine before anesthesia and during delivery consumed less sufentanil and ondansetron during their hospitalization and had a slightly shorter time to the first production of milk than women in the other groups (25 minutes vs 27 to 28 minutes).
来源:Drugs and Lactation Database (LactMed)