Herbal product use and perioperative patients

AORN Journal, May, 2004 by Cheryl MacKichan, Jacklyn Ruthman

Reports of serious adverse reactions or side effects from herbal products are rare in comparison to pharmaceutical medications. An estimated 106,000 deaths occur each year in hospitalized patients because of adverse reactions to appropriately prescribed pharmaceutical medications. (30) Many of the most commonly used herbal products usually are harmless if taken as recommended in appropriate doses. European studies that monitored thousands of people taking ginkgo biloba, St John's wort, and other commonly prescribed herbal products determined that the adverse effects of these medications primarily are mild. Side effects were described as infrequent dermatological reactions or gastrointestinal distress. These adverse effects were seen in less than 3% of the population and occurred at the same rate as in placebo groups. (19) The reportedly low incidence of side effects from herbal products may reflect several factors, including the weaker pharmacological activity of herbal products, the lack of an established reporting system for adverse reactions to herbal products, and overall less consistent use of herbs by patients. (11,16,19)

HERBAL PRODUCT USE AND PERIOPERATIVE PATIENTS

The significant increase in herbal product use in the United States, combined with the increase in consumer interest in alternative and herbal therapies in the past decade, has important implications for perioperative patients. Scientific evidence is not available to clearly show the potential interactions between herbal and modern pharmaceuticals. One area of concern is the interaction of herbal products with anesthetic agents. Patients who have not informed health care providers about their herbal product use are in danger of experiencing potentially life-threatening adverse reactions or herb-medication interactions when anesthesia is administered during surgical procedures. For the perioperative patient, "the prevention, recognition, and treatment of complications begin with explicitly eliciting and documenting a history of herbal medicine use." (7) (p208)

Conclusions drawn from authors discussing herbal product use suggest that health care providers in every setting must be familiar with the scientific literature on herbal medicine and other alternative therapies. This knowledge will help providers ask appropriate, nonjudgmental questions about product names, dosages, frequency, side effects, and the client's perception of effectiveness regarding herbal product use when obtaining patient histories. (31) Being educated and well informed about herbs and herbal products, including having knowledge of current research, allows health care providers to answer patients' questions and address concerns. (4,5,7,11,18) Although, information is not yet available regarding all potential side effects and interactions from herbal products, providers can anticipate possible problems so care can be planned accordingly. (31)

Currently, it is recommended that use of herbal products be discontinued two to three weeks before surgery. The American Society of Anesthesiologists does not have an official standard, but it suggests this period of time as a guideline. (21) This may be an impossible expectation in practice considering the number of nonelective surgical procedures performed each year. (7) Being knowledgeable about the most commonly used herbal products and being able to recognize and treat complications is a priority. Discontinuation of herbal products before surgery does not ensure that patients will be free of the risk of complications during the procedure. Complications still may occur in the perioperative and postoperative periods. More knowledge, therefore, is needed to recognize problems that may arise.