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More than $5 billion will be spent on herbal products this year, and seven out of 10 people using these products will not tell their physicians, according to the American Society of Anesthesiologists (ASA) in Park Ridge, IL.
While many people may benefit from herbal medications, also called botanicals, the patient who is undergoing surgery must disclose the use of botanicals to his or her physicians prior to surgery, says Jessie A. Leak, MD, associate professor in the department of anesthesia at M.D. Anderson Cancer Center in Houston and a researcher who specializes in the study of herbal medication.
Potential interactions with drugs used for anesthesia as well as prescription medications the patient is already using can occur if the surgeon and anesthesiologist are unaware of the herbal medication’s use, Leak advises.
"There have not been enough studies of botanicals in the United States for us to state that there definitely will or won’t be a reaction during surgery, but most anesthesiologists and surgeons will err on the side of caution," she says. "We definitely need more botanical research, but based on anecdotal stories and the personal experiences of ASA members, we do recommend discontinuing some herbal medications at least two to three weeks prior to surgery."
Some of the more common herbal medications and their potential complications they could cause during surgery, according to Leak, are:
Ginseng is used to enhance energy levels. If combined with stimulants used by anesthesiologists, it can cause tachycardia and high blood pressure. It can also decrease the effect of warfarin, causing the blood to thicken and develop clots.
Ephedra is included in over-the-counter diet aids. It interacts with inhalants used for anesthesia to affect blood pressure. If used with monoamine oxidase inhibitors or oxytocin, the patient can experience high blood pressure and irregular heart rate during surgery.
Feverfew is often used to treat migraines. It inhibits platelet activity that can increase bleeding during surgery.
Garlic is used to lower lipids and as an antioxidant. It inhibits platelet activity, especially if the patient is already taking warfarin.
Valerian has a mild sedative effect to help sleep. It causes a potential increase in the effect of barbiturates used in anesthesia, which causes a deeper effect of anesthesia.
• Ginkgo biloba.
Ginkgo biloba is a circulatory stimulant. It decreases platelet activity and clotting ability.
• St. John’s Wort.
St. John’s Wort is used to treat anxiety and depression. It may prolong the effects of some narcotics and anesthetics.
Licorice treats symptoms of gastritis and duodenal ulcers. It can cause edema and chronic liver problems and increase the risk of renal insufficiency.
Echinacea is used to enhance the immune system. It may cause hepatoxicity and cause liver damage.
Ginger treats nausea. It can increase bleeding time.
Goldenseal is a diuretic and laxative. It can worsen edema and increase blood pressure.