G
Gillian (in UK)
Question for David C (if you and your wife are still around) and anyone else with special knowledge or interested.
Should people going for surgery take the following report seriously?
Tuesday, 10 July, 2001, 23:52 GMT 00:52 UK
Herbal remedies 'pose surgery risk'
Herbal medicines can have many side effects
Patients are being warned that herbal medications can
increase the risk of serious complications during surgery.
The preparations can speed up or slow down the heart rate,
inhibit blood clotting, alter the immune system and change
the effects and duration of anaesthesia.
Physicians need to specifically ask patients about herbal
medication use
Professor Jonathan Moss
And scientists have found some preparations have an impact
if taken up to a week before a patient goes under the knife.
Among the popular herbs studied were echinacea, gingko
biloba, garlic, St John's wort and valerian - all
widely-available in tablet form.
The researchers, from the University of Chicago, have
published guidelines on when patients should stop taking
herbal medicines in the influential Journal of the American
Medical Association.
They hope that their work will encourage doctors to discuss
the potential dangers with patients.
Researcher Dr Chun-Su Yuan said: "While most of these
substances appear to be safe for healthy people, for
surgical patients they can affect sedation, pain control,
bleeding, heart function, metabolism, immunity and recovery
in ways that we are just beginning to understand."
Popular medications
Studies suggest that as many as one third of pre-surgical
patients take herbal medications.
However, many of those patients fail to disclose herbal use
during pre-operative assessment, even when prompted.
Further, doctors often are unsure what to do with the
information.
Professor Jonathan Moss, who also worked on the research,
said: "Physicians need to specifically ask patients about
herbal medication use.
"Many patients think of herbal medications not as
supplements but as drugs.
"Other patients may not want to admit to their use to
physicians.
"But in order to optimise patient safety and pain control
during and after surgery, we need to know what herbal as
well as over-the-counter or prescription drugs each patient
takes."
Current guidance
The American Society of Anesthesiologists has recognised the
potential for adverse reactions and suggests that patients
stop taking all herbal medications two weeks before surgery.
This advice may be difficult to implement, however, since
most preoperative evaluations occur only a few days prior to
surgery.
So the Chicago researchers began to search for more targeted
recommendations.
They focused on the eight most common herbs - echinacea,
ephedra, garlic, gingko biloba, ginseng, kava, St. John's
wort, and valerian - which account for 50% of all
single-herb preparations sold.
They warn that the ingredients of herbal medications vary
enormously from maker to maker, that potency and purity are
inconsistent, and that product labels are not always
accurate.
But they believe the guidelines are useful as many doctors
remain unaware of the potential risk.
More than 5,000 suspected herb-related adverse reactions
were reported to the World Health Organisation before 1996,
said the researchers.
Between 1993 and 1998 a total of 2,621 adverse reactions,
including 101 deaths, were reported to the United States
Food and Drug Administration.
Echinacea
Relevant effects: Boosts immunity.
Concern during surgery: Allergic reactions, impairs
immune suppressive drugs, could impair wound healing.
Recommendations: Discontinue as far in advance as
possible.
Ephedra
Relevant effects: Increases heart rate & blood pressure.
Concern during surgery: Risk of heart attack, stroke,
interaction with other drugs, kidney stones.
Recommendations: Discontinue at least 24 hours before
surgery.
Garlic
Relevant effects: Prevents clotting.
Concern during surgery: Risk of bleeding.
Recommendations: Discontinue at least 7 days before
surgery.
Ginko
Relevant effects: Prevents clotting.
Concern during surgery: Risk of bleeding.
Recommendations: Discontinue at least 36 hours before
surgery.
Ginseng
Relevant effects: Lowers blood glucose, inhibits
clotting.
Concern during surgery: Increases risk of bleeding.
Interferes with anti-clotting drug.
Recommendations: Discontinue at least 7 days before
surgery.
Kava
Relevant effects: Sedates, decreases anxiety.
Concern during surgery: May increase sedative effects of
anesthesia.
Recommendations: Discontinue at least 24 hours before
surgery.
St. John's wort
Relevant effects: Acts like anti-depressants such as
Prozac.
Concern during surgery: Alters metabolisms of other
drugs.
Recommendations: Discontinue at least 5 days before
surgery.
Valerian
Relevant effects: Sedates.
Concern during surgery: Long-term use could increase the
amount of anesthesia needed.
Recommendations: Taper dose weeks before surgery.
Should people going for surgery take the following report seriously?
Tuesday, 10 July, 2001, 23:52 GMT 00:52 UK
Herbal remedies 'pose surgery risk'
Herbal medicines can have many side effects
Patients are being warned that herbal medications can
increase the risk of serious complications during surgery.
The preparations can speed up or slow down the heart rate,
inhibit blood clotting, alter the immune system and change
the effects and duration of anaesthesia.
Physicians need to specifically ask patients about herbal
medication use
Professor Jonathan Moss
And scientists have found some preparations have an impact
if taken up to a week before a patient goes under the knife.
Among the popular herbs studied were echinacea, gingko
biloba, garlic, St John's wort and valerian - all
widely-available in tablet form.
The researchers, from the University of Chicago, have
published guidelines on when patients should stop taking
herbal medicines in the influential Journal of the American
Medical Association.
They hope that their work will encourage doctors to discuss
the potential dangers with patients.
Researcher Dr Chun-Su Yuan said: "While most of these
substances appear to be safe for healthy people, for
surgical patients they can affect sedation, pain control,
bleeding, heart function, metabolism, immunity and recovery
in ways that we are just beginning to understand."
Popular medications
Studies suggest that as many as one third of pre-surgical
patients take herbal medications.
However, many of those patients fail to disclose herbal use
during pre-operative assessment, even when prompted.
Further, doctors often are unsure what to do with the
information.
Professor Jonathan Moss, who also worked on the research,
said: "Physicians need to specifically ask patients about
herbal medication use.
"Many patients think of herbal medications not as
supplements but as drugs.
"Other patients may not want to admit to their use to
physicians.
"But in order to optimise patient safety and pain control
during and after surgery, we need to know what herbal as
well as over-the-counter or prescription drugs each patient
takes."
Current guidance
The American Society of Anesthesiologists has recognised the
potential for adverse reactions and suggests that patients
stop taking all herbal medications two weeks before surgery.
This advice may be difficult to implement, however, since
most preoperative evaluations occur only a few days prior to
surgery.
So the Chicago researchers began to search for more targeted
recommendations.
They focused on the eight most common herbs - echinacea,
ephedra, garlic, gingko biloba, ginseng, kava, St. John's
wort, and valerian - which account for 50% of all
single-herb preparations sold.
They warn that the ingredients of herbal medications vary
enormously from maker to maker, that potency and purity are
inconsistent, and that product labels are not always
accurate.
But they believe the guidelines are useful as many doctors
remain unaware of the potential risk.
More than 5,000 suspected herb-related adverse reactions
were reported to the World Health Organisation before 1996,
said the researchers.
Between 1993 and 1998 a total of 2,621 adverse reactions,
including 101 deaths, were reported to the United States
Food and Drug Administration.
Echinacea
Relevant effects: Boosts immunity.
Concern during surgery: Allergic reactions, impairs
immune suppressive drugs, could impair wound healing.
Recommendations: Discontinue as far in advance as
possible.
Ephedra
Relevant effects: Increases heart rate & blood pressure.
Concern during surgery: Risk of heart attack, stroke,
interaction with other drugs, kidney stones.
Recommendations: Discontinue at least 24 hours before
surgery.
Garlic
Relevant effects: Prevents clotting.
Concern during surgery: Risk of bleeding.
Recommendations: Discontinue at least 7 days before
surgery.
Ginko
Relevant effects: Prevents clotting.
Concern during surgery: Risk of bleeding.
Recommendations: Discontinue at least 36 hours before
surgery.
Ginseng
Relevant effects: Lowers blood glucose, inhibits
clotting.
Concern during surgery: Increases risk of bleeding.
Interferes with anti-clotting drug.
Recommendations: Discontinue at least 7 days before
surgery.
Kava
Relevant effects: Sedates, decreases anxiety.
Concern during surgery: May increase sedative effects of
anesthesia.
Recommendations: Discontinue at least 24 hours before
surgery.
St. John's wort
Relevant effects: Acts like anti-depressants such as
Prozac.
Concern during surgery: Alters metabolisms of other
drugs.
Recommendations: Discontinue at least 5 days before
surgery.
Valerian
Relevant effects: Sedates.
Concern during surgery: Long-term use could increase the
amount of anesthesia needed.
Recommendations: Taper dose weeks before surgery.