Herbal medicine

A group of Chicago researchers warns that patients slated for surgery often neglect to give their physicians a significant piece of medical information - the types and doses of herbal medications they have recently taken. As reported in a recent issue of the Journal of the American Medical Association, the researchers say that seemingly benign herbal preparations can be potent enough to significantly affect surgical outcomes.

To illustrate this point, the researchers scanned recent medical literature for information on the pharmacology of eight of the most commonly used herbs: echinacea, ephedra, ginkgo, ginseng, garlic, kava, St. John's wort, and valerian. This search yielded several significant 'red flags' of which both physicians and their patients should be aware.

Potential problems

For instance, ginkgo and ginseng - popular herbs that many seniors take to bolster failing memory and boost energy - can interfere with normal platelet aggregation. Garlic consumed in therapeutic doses for 'heart health' could have a similar effect.

St. John's wort, used as a short-term treatment for mild depression, interferes with the action of medications used during and after surgery, including some anesthetics, warfarin, and lidocaine. Ephedra, a powerful vasoconstrictor that is a common ingredient in over-the-counter weight loss preparations, can cause cardiac irregularities when combined with anesthesia.

Echinacea - when used continually for more than 8 weeks - may suppress the immune system, a consequence that would lead to increased wound healing time and a greater risk of infection.

Both kava and valerian are sedatives, and as such may augment the effects of anesthetics and auxiliary medications. Kava clears the system quickly, but people who regularly rely on valerian to help them sleep should taper off use of the herb over a period of weeks.

Educate your patients

In fact, the American Society of Anesthesiologists suggests that patients discontinue all herbal medications 2 to 3 weeks before surgery. This is fine if surgery is scheduled for some time in the future. But since some procedures are performed on short notice, it is not always possible to insure that a person is 'herb-free' before surgery. This points to the importance of patients keeping their physicians fully informed of all dietary supplements that they are using to treat conditions - like a cold or sleep disorder - not listed on their medical records.

The authors say that many patients will not volunteer this information unless prompted to do so. Some people don't think of herbs as 'real medicine', and others are afraid that their physician will disapprove of their using alternative forms of medicine. To compound the problem, one in five people can't identify exactly what they are taking.

The solution is to ask patients for a list of all dietary supplements that they are currently using, with a detailed account of how much they've used in recent weeks. Armed with advance knowledge, physicians can take steps to minimize the residual effects of these medications on their surgical patients.