Herbal medicines: current trends in anesthesiology practice—a hospital survey

doi:10.1016/S0952-8180(00)00195-1

Journal of Clinical Anesthesia

Volume 12, Issue 6, September 2000, Pages 468-471

https://doi.org/10.1016/S0952-8180(00)00195-1 Get rights and content

Abstract

Study Objectives: To develop a simple survey to determine the patient population actively utilizing dietary supplements and/or herbs, during the preoperative period.

Design: Prospective study, with survey instrument.

Setting: University medical center.

Patients: 1,017 patients presenting for preanesthetic evaluation prior to outpatient surgery.

Interventions: After undergoing preanesthetic evaluation, patients were asked to complete a survey listing which of the nine most popular nutraceuticals currently available on the market they were using.

Measurements and Main Results: A total of 1017 surveys were submitted over a period of five months, with 32% being poorly completed and thus discarded. Of the remaining 755 valid surveys, 482 patients used at least one nutraceutical agent. 90% of these patients were using vitamins, 43% garlic extracts, 32% Gingko Biloba, 30% St. John’s Wort, 18% Ma Huang, 12% Ecchinaceae, 10% Aloe, 8% Cascare, 3% licorice.

Conclusion: A significant population of patients scheduled for an elective surgical procedure are self-administering nutraceutical agents. Some of these agents have the potential to cause serious drug interactions and hemodynamic instability during surgery. Hence, it may be important to identify patients self-administering these medications, during the preoperative period.

Introduction

There has been a significant increase in the proliferation and use of dietary supplements including nutraceuticals over the past two decades. Nutraceuticals include all herbal medications, medicinal foods, and vitamins. Although herbal products are neither prescribed nor often recommended by traditional health care providers, patients seeking conventional and unconventional health care are more commonly using these over-the-counter substances. There are more than 29,000 herbal and related substances presently used or available for consumption in the United States.1 The majority of patients do not reveal their use of herbs to their health care providers. In part, patients often consider the herbs to be mere supplements and not constituting drugs or other forms of medicine. When presenting for surgical procedures, such patients may pose a considerable challenge or risk for anesthesiologists in unexpected anesthetic responses during surgery.2, 3 To date, there are no data on the incidence and prevalence of herbal and dietary supplemental use among surgical patients. To address this problem, we administered a survey to 1,017 patients presenting for preanesthetic evaluation in the outpatient clinic of the Department of Anesthesiology at the Texas Tech University Health Sciences Center in Lubbock, Texas.

The purpose of this study was to create awareness among clinical anesthesiologists regarding the use of herbal medicines by patients presenting for a preanesthetic evaluation. As some of these herbs are known to cause unexplained and potentially serious intraoperative hemodynamic alterations, increased bleeding tendencies, and other herb-anesthetic interactions, it becomes prudent for the anesthesiologist to possess a reasonable knowledge and an understanding of these important agents.

Section snippets

Materials and methods

The herbal survey was developed on the basis of a market study involving leading pharmacies and health stores. An inquiry into the names of the most commonly sold herbal products was performed and the most commonly used herbal products/constituents were then incorporated into the study survey.

After approval by the Institutional Review Board at Texas Tech University Medical Center, Lubbock, Texas, the nutraceutical survey was administered. Patients were first evaluated preoperatively by members

Results

Approximately one in three (32%) of patients admitted to self-administering one or more herb-related compound. Further, the results of the present study reveal that nearly 70% of patients who were taking one or more herbal related agent did not report this information when asked about it during routine anesthetic assessment. Demographic data of the survey population include 58% males and 42% female patients, age range from 18 to 80 years, 53% Caucasians, 33% Hispanics, and 14% blacks and other

Discussion

According to one estimate, 20% of the adult population in the United States use herbal medicines along with prescription drugs.4 In recent years, expenditures on herbal therapies alone have risen to an excess of $5 billion per year.5 Approximately 42% of adult Americans have used at least one alternative therapy (including yoga, relaxation techniques, etc.) in recent years.4 Patients with chronic ailments (e.g., diabetes, arthritis, AIDS, cancer), resort to alternative modalities to

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For binary logistic regression the predictors were significant for the following outcomes: taking DS (education, sex, age, and race; P < .05), knowledge of side effects (age, race, and rank; P < .05), and believe they are having side effects (age; P < .05).
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Adequate preparation of children for anesthesia allows optimization of medical conditions and leads to decreased morbidity. The medical history and laboratory testing obtained preoperatively aid the anesthesiologist in determining readiness for the planned surgery. Preparedness begins with adherence to a preoperative fasting schedule for elective surgery, selecting appropriate premedication, formulating an anesthetic plan and anticipating postoperative concerns.
There are a variety of techniques for inducing general anesthesia. The technique used depends on a number of factors including the child's developmental age, understanding and ability to cooperate, previous experiences, the presence of a parent and the interaction of these factors with the child's underlying medical or surgical conditions.
This chapter discusses special problems encountered in the pediatric population that require additional considerations from anesthesiologists. The preoperative period can be a stressful time for the fearful child and for those with autism spectrum disorders thus requiring the anesthesiologist to tailor the approach to meet the child's needs. Other challenges that pediatric patients present include respiratory system conditions such as obstructive sleep apnea syndrome, bronchopulmonary dysplasia, difficult airway, upper respiratory tract infections and apnea in former preterm infants. Additional conditions that are discussed include diabetes, seizure disorders, and sickle cell disease. Finally, the detection of a cardiac murmur, anemia or a fever before elective surgery will present a dilemma whether to proceed.
The preoperative visit is an essential component of identifying the pediatric patient's needs and devising a plan that leads to a superior patient experience, a decrease in the number of cancellations and improved outcomes.
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¹: Professor and Chairman

²: Resident

³: Clinical Research Fellow

⁴: Instructor

⁵: Research Professor

⁶: Assistant Professor

⁷: Clinical Assistant Professor of Pharmacy

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Article preview

Journal of Clinical Anesthesia

Abstract

Introduction

Section snippets

Materials and methods

Results

Discussion

References (14)

inhibition of thromboxane synthetase and stimulation of prostacyclinrelevance for medicine and psychiatry

Med Hypoth

Subarachnoid hemorrhage associated with Gingko biloba

. Lancet

Pre-anesthetic assessment of a patient taking herbal medicines (Part I)

Anesthesiology News Feb

Pre-anesthetic assessment of a patient taking herbal medicines (Part II)

Anesthesiology News March

Herbal medicineis it an alternative or an unknown? A brief review of popular herbals used by patients in a pain and symptom management practice setting

Curr Rev Pain

Trends in alternative medicine use in the United States, 1990–1997

JAMA

Cited by (170)

Safety perception and determinants of complementary and alternative medicine usage among surgery out-patients in LAUTECH Teaching hospital, ogbomoso, Nigeria

Exploration of Predictive Modeling of Defense Health Agency & Department of Veterans Affairs Beneficiaries Dietary Supplements Use

Preoperative Evaluation, Premedication, and Induction of Anesthesia

Preoperative Evaluation, Premedication, and Induction of Anesthesia

Anticoagulation and Neuraxial/Peripheral Anesthesia

Postoperative Analgesia in Morbid Obesity: An Overview of Multimodal Analgesia and Complimentary Therapies

Original contributionHerbal medicines: current trends in anesthesiology practice—a hospital survey

Abstract

Introduction

Section snippets

Materials and methods

Results

Discussion

Med Hypoth

. Lancet

Pre-anesthetic assessment of a patient taking herbal medicines (Part I)

Anesthesiology News Feb

Pre-anesthetic assessment of a patient taking herbal medicines (Part II)

Anesthesiology News March

Herbal medicineis it an alternative or an unknown? A brief review of popular herbals used by patients in a pain and symptom management practice setting

Curr Rev Pain

Trends in alternative medicine use in the United States, 1990–1997

JAMA

Original contribution
Herbal medicines: current trends in anesthesiology practice—a hospital survey