A surgeon’s guide to herbal supplements

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Abstract

The use of herbal supplements has steadily increased in the United States over the last decade. Despite the increased awareness of alternative therapies by the government and lay public, many physicians do not ask their patients about their use of these alternative medications. In addition, many physicians are unaware of the possible side effects that may occur when a patient consumes these substances. Considering a number of these supplements have been associated with adverse reactions in the perioperative period, it is important for a surgeon to understand all of the herbs a patient may be taking. The purpose of this article is to discuss the growing trend of herbal use among surgical patients and give the reader some background on the most commonly used herbs.

Introduction

The use of herbs among the general population is increasing. Studies have shown that many surgical patients fail to inform their anesthesiologist and surgeon of their use of herbs in preoperative interviews. In many cases, patients continue their herbs in the perioperative period. Although data concerning the effects of herbal use in the perioperative period is lacking, anesthesiologists and surgeons should be aware of the potential side effects these herbs may have.

The purpose of this review is to give a brief overview of the current knowledge of herb use in our society. Additionally, we will discuss selected herbal medicines and potential perioperative complications that can arise from their use. Given that there are more than 20,000 herbal medicines on the market, and that a survey of 364 surgical patients found that 37.5% reported using 1 of 62 herbs [1], a review of all herbs is impossible [2].

Section snippets

Epidemiology

It is estimated that up to 3–97% of the U.S. population takes herbal remedies on a regular basis 3, 4. Eisenberg found that the use of herbal remedies increased 380% from 1990–1997, and estimated that 1 in 5 individuals taking prescription medications were also taking one or more herbs [5]. Surprisingly, the majority of information regarding herbal remedies resides in the nursing and nutritional literature, with a minority in the medical literature [6]. Among surgical patients, females more

Ephedra (ephedra sinica, Ma huang)

Ephedra is the herbal precursor to ephedrine and pseudoephedrine and therefore is a potent stimulant. Ephedra containing compounds are consumed by 18% of patients preoperatively [11]. The herb is commonly used by the young, the overweight, and females [28]. Typical uses for this herb include treatment of respiratory illnesses, weight loss, body building enhancer, and as a stimulant. Adverse side effects of ephedra-containing drugs include tachycardia, palpitations, angina, seizures, panic

Conclusion

The use of herbal remedies is constantly increasing in the United States because of patient perceptions that natural is better [88]. Many patients begin these herbs without a physician’s recommendation or knowledge, and a substantial number of patients continue to take them preoperatively. Many primary care physicians and anesthesiologists are unaware of the side effects of herbal medications. Until further, well-validated scientific evidence exists, we agree with the American Society of

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