A surgeon’s guide to herbal supplements
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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Cited by (27)
Risky business-Or is it? Risk perception and integrative medicine
2014, Advances in Integrative MedicineCitation Excerpt :Another safety issue which gained interest at a similar time was the use of herbal and dietary supplements before surgery. Between 2000 and 2003, at least 10 reviews were published in anaesthesia, surgery, nursing, medical and complementary medicine journals regarding concerns about the perioperative safety of dietary supplements [11–21]. A key focus was on substances that could increase bleeding and herbs such as ginger (Zingiber officinales), ginkgo (Ginkgo biloba), garlic (Allium sativum) and feverfew (Tanacetum parthenium) were consistently implicated.
Complementary and Integrative Treatments: Facial Cosmetic Enhancement
2013, Otolaryngologic Clinics of North AmericaCitation Excerpt :Of the direct pharmacologic effects, the putative risk of bleeding imparted by the use of various herbal medicines is of particular concern. Certain remedies can increase the risk of intrinsic bleeding, which can result in serious problems for plastic surgeons and their patients.83,84 Some herbals inherently possess significant pharmacologic activity to antagonize normal platelet aggregation and coagulation mechanisms; others contain coumarins, and their plants are similar in structure to warfarin.85
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2012, Dental Clinics of North AmericaCitation Excerpt :Preoperatively, the surgeon should assess the bleeding risk of the patient as well as the bleeding risk of the surgery. For example, extracting multiple teeth in a single visit greatly increases the risk of perioperative bleeding.6 Patients with severe periodontal disease or gingival inflammation are also placed at a higher risk of perioperative bleeding.
The use of herbal preparations as complementary and alternative medicine (CAM) in a sample of patients with cancer in Jordan
2010, Complementary Therapies in Clinical PracticeCitation Excerpt :On the other hand, herbal medicines should be considered harmful when they delay or replace a more effective form of conventional treatment or if they compromise the efficacy of conventional medicines.20,22 Clinicians need to be aware of CAM-induced side effects or interactions and identify hazards.49,50 If the predictable risks of plant/drug use can be avoided and CAM was successful in relieving symptoms and improves the physical well-being of the patients with a particular chronic disease, the new trend “Integrative Medicine” could be also in Jordan raised and critically evaluated.11
Herb and vitamin supplementation use among a general ophthalmology practice population
2005, American Journal of OphthalmologyCitation Excerpt :Still, educational and income levels were not predictive of patients’ use of CAM. Previous studies have shown a high rate of CAM use in the general medical population1–3 as well in glaucoma patients.7 Rhee and associates reported that 5.4% of glaucoma patients were using megadose vitamin therapy, herbals, exercise, special diets, acupuncture, and other forms of CAM.7