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In 1998, 20% of adults in the United States used herbs or nutritional supplements.1 In 2000, the number of adults using herbs or nutritional supplements rose to 49%.2 Those numbers are significant to same-day surgery managers, anesthesiologists, and surgeons because many of these products can affect a patient’s reaction to anesthesia or the surgical procedure, says Jessie A. Leak, MD, associate professor in the department of anesthesia at M.D. Anderson Cancer Center in Houston. (For more information on patients’ herb use, see Same-Day Surgery, August 1999.)
There has been a great deal of publicity about the potential interactions of herb use before surgery since the American Society of Anesthesiologists (ASA) in Park Ridge, IL, issued a warning in 1999, says Leak. The ASA statement encouraged patients to tell physicians about herb use prior to surgery because herbs might affect a patient’s reaction to anesthesia or surgery. The ASA also recommended that patients stop taking herbal medications two to three weeks before surgery.
"I’ve also spoken at many physician meetings to discuss the need for physicians to know what their patients are using and how herbs, nutritional supplements, and diet aids might interact with their medications or with surgery," Leak says.
A variety of potential interactions with herbs can occur during surgery, says Leak. Some herbs thin blood to increase circulation. If a patient taking one of those herbs is also taking a drug such as warfarin, there will be excessive bleeding during surgery, she explains. Other potential complications include high blood pressure, irregular heart rate, swelling, and increased effect of anesthetics, she adds.
To educate physicians and to help physicians educate their patients, Leak and the ASA produced two brochures that address herbs and surgery. One brochure, What You Should Know About Your Patients’ Use of Herbal Medicines, is directed at anesthesiologists and includes common and scientific names of the most common herbs as well as possible side effects and drug interactions. The second brochure, What You Should Know About Herbal Use and Anesthesia, is written in clear, easy-to-understand language for patients and contains a chart that also lists the uses and possible side effects of common herbs. (To see herbal chart, click here.) Both brochures are available from the ASA. (See "Source and resource" at end of article for ordering information.)
The increased publicity of the dangers of herb use has put pressure on the Food and Drug Administration (FDA) to take actions to warn or protect consumers; however, herbs, nutritional supplements, and dietary aids are not patented and not considered drugs, so the FDA’s role is limited, says Leak. The FDA can pull a product if it receives a significant number of reports of health problems associated with it, she adds. The FDA set up a Special Nutritionals Adverse Event Monitoring System in 1993 in an effort to track adverse events related to dietary supplements (many of which contain herbs), but in late 1998, the agency stopped monitoring most cases associated with herbs.3 "Budget restraints are often given as the reason for the decreased monitoring," says Leak.
"In spite of the many reports of adverse effects and even deaths associated with Ma-Huang [also known as Ephedra], there are still 5,000 products that contain Ma-Huang on the market," says Leak.
In addition to warning physicians about their patients’ use of herbs, Leak also warns physicians about dietary supplements that might be dangerous. GHB (gamma hydroxybutyric acid), GBL (gamma butyrolactone), and Triax Metabolic Accelerator (manufactured by Syntrax Innova-tions in Cape Girardeau, MO) are all associated with dangerous side effects, she adds.
"The FDA has found that although these three substances are marketed as diet aids, they are actually potent, nonapproved drugs," Leak says. Same-day surgery managers and physicians can stay up to date on warnings related to herbs, nutritional supplements, and dietary aids by visiting the FDA Web site (www.fda.gov), says Leak.
In spite of the increase of herbal use, Leak says she is pleased that more publicity has been given to the potential side effects and complications. "It is very important that physicians continue to increase their awareness of herb use and keep asking patients about their use of herbs, nutritional supplements, and dietary aids," she says. "This can only improve patient care."
1. Eisenberg DM, Davis RB, Ettner SL, et. al. Trends in alternation medicine use in the United States, 1990-1997. JAMA 1998; 280:1,569-1,575.
2. Blumenthal M. Interactions between herbs and conventional drugs: Introductory considerations. HerbalGram 2000; 49:52-63.
3. Miller HI, Longtin D. Death by dietary supplement. Policy Review August/September 2000; 102:15-25.
For more information about herb use and anesthesia, contact:
• Jessie A. Leak, MD, Associate Professor, Department of Anesthesia, M.D. Anderson Cancer Center, 11515 Holcombe Blvd., Box 042, Houston, TX 77030. Telephone: (713) 792-6911. Fax: (713) 794-4590. E-mail: email@example.com.
A physician’s brochure, What You Should Know About Your Patients’ Use of Herbal Medicines, and a patient brochure, What You Should Know About Herbal Use and Anesthesia, are available from the American Society of Anesthesiologists. The cost is $15 per 100 copies. Orders can be submitted by mail, fax, or through the Web site. To order brochures, contact: American Society of Anesthesiologists, Publications Department, 520 N. Northwest Highway, Park Ridge, IL 60068-2573. Telephone: (847) 825-5586. Fax: (847) 825-1692. Web: www.ASAhq.org.