Use Caution When Taking Herbal Remedies Prior to Surgery

CHICAGO While most patients know to inform their doctors about their medical history and prescription medication use, a new study and editorial in this months Anesthesiology verify the continued need for patients to inform physicians of their herbal supplement use as well especially prior to surgery.

The study Incidence and Risk of Adverse Perioperative Events among Surgical Patients Taking Traditional Chinese Herbal Medicines by Anna Lee, PhD, MPH, and the accompanying editorial, Herbal Medicines and Perioperative Care by Jonathan Moss, MD, PhD, and Chun-Su Yuan, MD, PhD, of the University of Chicago Hospitals, found an increased risk of adverse events in the preoperative period for patients taking traditional Chinese herbal medications (TCHM) prescribed by a traditional Chinese medicine practitioner, compared to patients taking self-prescribed TCHM.

Examining the results of the study, Moss and Yuan found that although it is encouraging that the results did not indicate specific major outcome changes for patients taking over-the-counter herbal supplements, patients and physicians need to remain aware that adverse interactions caused by herbs could still manifest in events before, during and after surgery. While taking herbal medications may not be as dangerous as once believed, study indications point to the need for identification of herbal supplement use by patients and warrant the discontinuation of the use of herbs before surgery.

Users of TCHM by prescription were found to be more than two times more likely to experience low levels of potassium and/or impaired clotting than non-users in the preoperative period. The duration of anesthesia was also longer in users of TCHM by prescription than with self-prescribed users of TCHM. A main caveat to the findings is that the study evaluated traditional Chinese medicines which contain complex mixtures of a variety of herbs. Without standardization of these mixtures, it is difficult to identify what herbal quantities patients are actually receiving.

According to the American Society of Anesthesiologists (ASA), patients often take herbal products for various purposes; however, certain herbal supplements may prolong the effects of anesthesia, while others may increase the risk of bleeding or raise blood pressure. Some effects may be subtle and less critical, but for anesthesiologists monitoring patients vital life functions before, during and after surgery, anticipating a possible reaction is better than reacting to an unexpected condition.

In continued efforts to improve the anesthesia experience and increase patient safety in medicine, ASA offers the following suggestions on herbal supplement usage for patients to keep in mind as they prepare for surgery.

-- Natural doesnt always mean safe. Many herbal products on the market can cause harmful side effects or interact with your other medicines and anesthetics.

-- To prevent unforeseen complications, it is imperative that health care providers as well as patients become aware of the interactions of these products and that herbal use habits become a part of a patients documented history and treatment plan.

-- Herbs and other dietary supplements do not undergo the same strict research requirements as prescription drugs and are not subject to FDA testing before being put on store shelves.

-- Patients should tell their physicians and physicians should ask about all herbal, dietary or other over-the-counter preparations as well as prescription medicine that the patient its taking.

Source: American Society of Anesthesiologists (ASA)