Herbal Medicines and Perioperative Care

THERE IS ENORMOUS PUBLIC ENthusiasm for herbal medications. Two recent surveys have found widespread use among the presurgical population. Morbidity and mortality associated with herbal medications may be more likely in the perioperative period because of the polypharmacy and physiological alterations that occur. Such complications include myocardial infarction, stroke, bleeding, inadequate oral anticoagulation, prolonged or inadequate anesthesia, organ transplant rejection, and interference with medications indispensable for patient care. Of the herbal medications that clinicians are likely to encounter, we have identified 8 of the herbs that potentially pose the greatest impact to the care of patients undergoing surgery. These herbs account for more than 50% of all single herb preparations among the 1500 to 1800 herbal medications sold in the United States. Nonherbal dietary supplements, such as vitamins, minerals, amino acids, and hormones, are beyond the scope of this review. Some of these nonherbal dietary supplements that patients undergoing surgery are most likely to take, such as glucosamine and chondroitin for osteoarthritis, appear to be safe. Limited information is available, however, on the use of these supplements in the presurgical population. In this article, we consider safety and US regulatory issues for herbal medications; review the literature on the identified 8 commonly used herbal medications as they affect perioperative care; and propose rational strategies for managing the preoperative use of these agents. The prevention, recognition, and treatment of complications begin with explicitly eliciting and documenting a history of herbal medicine use. Familiarity with the scientific literature on herbal medications is necessary because the current US regulatory mechanism for commercial herbal preparations sold in the United States does not necessarily protect the population against unpredictable or undesirable effects. Our goal is to provide a framework for physicians practicing in the contemporary environment where widespread herbal medicine use occurs.