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Herbal Medications and Anesthesia: Another Study Warns About Problems

(Originally posted 18 July 2001 on About Anesthesiology)

A study published in the July 11, 2001 issue of the Journal of the American Medical Association adds its voice to the large number of warnings for patients taking herbal supplements and scheduled to undergo surgery and anesthesia. Researchers at the Tang Center for Herbal Medicine Research, located at the University of Chicago, examined the published medical literature for evidence that complications could arise during surgery and anesthesia as the result of the use of herbal medications. While they did not find any controlled, randomized research (considered the best scientific evidence) to indicate that herbal supplements were harmful, they noted a number of case reports that they state should be taken seriously.

Since herbal medications are not controlled by the Food and Drug Administration, there is little incentive to perform standard scientific investigations on them. Therefore, a list of studies that proves that these medications are effective, safe or unsafe simply does not exist. While some adverse reactions and complications have been reported, there is no organized or comprehensive reporting mechanism. As a result, it is likely that many complications simply go unreported and unexamined.

While surgery and anesthesia are generally safe, especially in patients of generally good health, it is important for patients to realize that herbal supplements are biologically active and can interact with medications. The proper reporting of their usage to physicians and other health care providers can be essential in maximizing safety. Estimates are that up to fifty percent of patients may be using herbal supplements of one form or another, and many patients are reluctant to mention these if not specifically asked about herbal medications. Physicians should ask all patients during routine questioning about this possibility.

The American Society of Anesthesiologists (ASA) recommends that all patients stop these herbal medications at least two to three weeks prior to surgery to avoid the possibility of interactions and complications. In this recent study, the researchers have more specific recommendations based on case reports.

Examples of these case reports include a patient who developed serious bleeding during a gallbladder surgery. It appears that the bleeding might have been related to the popular supplement Ginkgo Biloba. Another patient had bleeding near the spinal cord as a result of high doses of garlic, and required surgery to avoid more serious complications. The researchers recommend that Ginkgo Biloba be stopped at least thirty-six hours before surgery and that garlic supplements be discontinued at least seven days before surgery.

In addition to these medications, the recommendations referred to ginseng, St. John's Wort, ephedra, kava, echinacea and valerian. Specifically, ginseng and St. John's Wort may increase bleeding and interact with other drugs. Therefore, these two drugs should be discontinued at least one week before surgery. Ephedra and kava may have effects on blood pressure and heart rate as well as interfere with anesthetic medications; they should be stopped at least thirty-six hours before surgery. Echinacea may contribute to allergic reactions and kava may increase sedation associated with anesthesia, although it is unclear how long before surgery they should be stopped.

For more information, here is the reference to the original article:

Herbal Medicines and Perioperative Care
Michael K. Ang-Lee; Jonathan Moss; Chun-Su Yuan
JAMA. 2001;286:208-216


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