Herbal Supplements and Surgical Risks

Herbal Remedies
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There is a recently published report on the risks of herbal supplements for patients undergoing surgery in the March/April issue of the Aesthetic Surgery Journal. The study points out that between 40-70% of patients tend to underreport the use of complementary medicines to their doctors. The authors mention that the reasons for this range from patients feeling that their physician won’t understand or won’t approve or may not have any knowledge about the supplements.

It is important that both patients and physicians realize the risk that some herbal supplements when combined with conventional medications.

The most popular herbal remedies noted by the researchers were chondroitin and glucosamine (both used as joint supplements), the banned stimulant ephedra, and echinacea (commonly used for colds).

Chondrotin and heparin (a blood thinner) are similar in chemical composition and researchers speculate that bleeding complications may arise from chondroitin use, particularly when used in combination with other blood-thinning medications.

Echinacea has immunostimulation properties, so it is contraindicated in systemic and autoimmune diorders. The immunostimulatory effects can offset the immunosuppressive actions of corticosteroids and cyclosporin. Side effects of echinacea also include GI upset, headache, dizziness, and potential allergic reactions.

Ephedrine, a chemical contained in ephedra, has medical uses, mostly in operating rooms and intensive care units. Of note, patients taking ephedra under general anesthesia can have severe hypotension that can be controlled with phenylephrine instead of ephedrine.

Rowe lists the herbal supplements that it is important for patients to stop taking two weeks before surgery.

These Herbal supplements that are known or suspected to increase bleeding risk include:

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* Gingko biloba
* Garlic
* Ginseng
* Fish oil
* Dong quai
* Feverfew

Herbal Supplements associated with cardiovascular risk include:

* Ephedra
* Garlic

Herbal Supplements with sedating effects that may prolong the effects of anesthesia include:

* Kava
* St. John's wort
* Valerian root

Herbal Supplements can also interact with other drugs:

* Licorice
* St John's wort
* Kava
* Valerian
* Echinacea
* Goldenseal

Sources

Perioperative Risks and Benefits of Herbal Supplements in Aesthetic Surgery; Aesthetic Surgery Journal, March/April 2009; vol 29: pp 150-157; Rowe, D.J.

Broughton, George II M.D., Ph.D., Col., M.C., U.S.A.; Crosby, Melissa A. M.D.; Coleman, Jayne M.D.; Rohrich, Rod J. M.D. Use of Herbal Supplements and Vitamins in Plastic Surgery: A Practical Review. Plastic & Reconstructive Surgery. 119(3):48e-66e, March 2007.

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