Herbal product use and perioperative patients

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

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Guidelines for preoperative assessment and patient education about herbal products have been proposed. These include

* avoiding herbal remedies if nursing or pregnant;

* checking facts about herbal product claims with a qualified health care professional;

* discontinuing use of herbal products if any untoward effect or unusual symptom occurs and reporting this to a health care provider;

* discussing herbal product use with all health care providers;

* purchasing herbal products that have been standardized in terms of known effects for a given dose;

* reading the labels of herbal products carefully;

* using caution when giving herbal products to children and older adults; and

* using only recommended products that are labeled with the

* scientific name of the herb;

* manufacture date;

* expiration date;

* lot number;

* proof of adherence to good manufacturing practice (ie, standards established for food processing);

* proof that the product has undergone scientific testing; and

* the address of the supplier. (18) (p183)

Three research-based reports are available regarding herbal products and preoperative surgical patients. These reports are descriptive studies that used self-report questionnaires about herbal product use before surgery. The conclusions drawn from these research reports indicate that herbal product use among preoperative patients is common, with 22% to 73% of patients reporting alternative medicine use. (3-6) Herbal products may prolong coagulation time, affect blood pressure, act as a sedative, affect cardiac function, or affect electrolytes. (5) About 50% of patients report discontinuing use before surgery. (4) This implies that the other 50% did not discontinue herbal product use before surgery, putting them at risk for complications. Surgery was cancelled for one patient with prolonged clotting times who had taken ginkgo biloba for several weeks before surgery. (4)

Reasons cited by patients for taking herbal products include

* self-prescribed to improve general health,

* recommendation from a friend or family member, and

* recommendation of a health care provider or media sources. (4,6)

Understanding reasons for taking herbal products may help health care providers tailor preoperative teaching so patients understand the importance of reporting use and, in many instances, discontinuing use before surgery.

It is evident that herbal medicine research, as it relates to implications for perioperative patients, is just beginning. It is important for clinicians to understand how herbal products function and how herb-medication interactions affect the perioperative patient.