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WHAT YOU SHOULD KNOW ABOUT HERBAL USE AND ANESTHESIA
Herbs include flowering plants, shrubs, trees, moss, fern, algae, seaweed or fungus. In most cultures, including Western culture, herbs are used not only as a part of the treatment of disease, but also in the enhancement of life, physically, emotionally and spiritually. Plant parts, including flowers, fruits, leaves, twigs, bark, roots or seeds, are all considered usable. In 1997, U.S. adults spent more than $3.5 billion on herbal products and billions more on vitamins, minerals and other dietary supplements.
Are they medicines?
The term "drug" comes from the ancient word for "root." Until the 1930s, medical schools taught that plant drugs were the primary medicines available. In general, since that time, patented pharmaceuticals (prescription or over-the-counter medications) have replaced the herbs or "roots," which were either found too weak or unsafe. Like drugs or foods, medicinal plants (herbs) have many actions in the body.
Are herbal medicines safe?
Sometimes, even if you take an herb for one certain reason, there can be other unintended reactions. Natural doesn't necessarily mean safe. Herbs have chemical properties just as manufactured drugs do. Like anything that we ingest (eat) or apply (like a salve), there can be side effects. One of the major problems with many of the herbs on the market today is that the amount and the purity of their active ingredients vary so greatly from product to product. In many cases, you do not always know how much of the herb you are really getting in each dose or if other ingredients have been added. Another problem is determining how much of each active ingredient is really safe, particularly over long-term use. There are even case reports of contaminated herbs causing death. Also, studies are being done to see how herbals react with other medications.
Does the federal government make sure that herbs are safe?
The government regulates herbal medicines in the same way that it regulates food and nutritional supplements, but herbal products do not undergo the same strict research requirements as prescription drugs or over-the-counter medications (like aspirin). Whole plants cannot be patented (meaning that no one manufacturer has exclusive rights to an herb) and therefore, nonpharmaceutical companies that produce herbal products are not obligated to do the same safety research that the Food and Drug Administration (FDA) requires for prescriptions or over-the-counter medications. If the FDA has reason to suspect that an herb is unsafe, then the agency may require it be removed from the market. By law, however, the FDA cannot require testing of all herbal products before they are put on the shelf.
In what types of preparations are herbal medicines available?
Herbs are available in many forms, depending on the type of plant and its use. Some plants are best used fresh, but they are highly perishable. Dried, chopped or whole herbs can be steeped as teas (infusions) or simmered over low heat (decoctions). Some fresh and/or dried herbs are preserved in alcohol (tinctures), while others are better suited to vinegar extracts (acetracts), syrups, glycerites (in vegetable glycerine) or miels (in honey). Freeze-dried or herbal powders also come in bulk, tablet, capsule, paste or concentrate (4 to 6 times regular strength). Other ways to administer herbs may be by suppositories, creams, gels, liniments, oils, compresses, steams, aromatics (oils) or baths.
Do I need to tell my doctor about all of the herbal products and other supplements that I take?
Yes. It is absolutely essential that you tell your doctor about any treatments that you are using. These include the use of herbal medicines, vitamins, nutritional supplements or any other prescribed or over-the-counter drugs. Many of the popular herbal products on the market can cause harmful side effects or interact with your other medicines.
Could herbal medicines affect my anesthesia if I need surgery?
Anesthesiologists are conducting research to determine exactly how certain herbals interact with certain anesthetics. They are finding that certain herbal medicines may prolong the effects of anesthesia. Others may increase the risks of bleeding or raise blood pressure. Some effects may be subtle and less critical, but for anesthesiologists, anticipating a possible reaction is better than reacting to an unexpected condition. So it is very important to tell your doctor about everything you are taking before surgery.
There are thousands of herbal products currently on the market. Listed on the reverse side are examples of some commonly used herbal medicines and their possible problems. Not all herbs are listed. Check with your doctor if you have any questions about the prescription or nonprescription medications that you are taking.
Following is a list of Commonly Used Herbs and their Possible Side Effects and Drug Interactions:
Echinacea
- Common uses: Boosts immune system and helps fight colds and flu; aids wound healing.
- Possible Side Effects: May cause inflammation of the liver if used with certain other medications such as anabolic steroids, methotrexate, and others.
Goldenseal
- Common uses: Used as a mild laxative and also reduces inflammation.
- Possible Side Effects: May worsen swelling and/or high blood pressure.
Ginseng
- Common uses: Increases physical stamina and mental concentration.
- Possible Side Effects: May cause decreased effectiveness of certain anticlotting medications. May see increased heart rate or high blood pressure. May cause bleeding in women after menopause.
Saw Palmetto
- Common uses: For enlarged prostate and urinary inflammations.
- Possible Side Effects: May see effects with other hormone therapies.
Ephedra (also called Ma-Huang)
- Common uses: Used in many over-the-counter diet aids as an appetite suppressant; also for asthma or bronchitis.
- Possible Side Effects: May interact with certain antidepressants or certain high blood pressure medicines to cause dangerous elevations in blood pressure or heart rate. Could cause death in certain individuals.
Ginkgo (also called ginkgo biloba)
- Common uses: For increasing blood circulation and oxygenation and for improving memory and mental alertness.
- Possible Side Effects: May increase bleeding, especially in patients already taking certain anticlotting medications.
Ginger
- Common uses: For reducing nausea, vomiting, and vertigo.
- Possible Side Effects: May increase bleeding, especially in patients already taking certain anticlotting medications.
St. John’s Wart
- Common uses: For mild to moderate depression or anxiety and sleep disorders.
- Possible Side Effects: May prolong effects of certain anesthetic agents.
Fever Few
- Common uses: Used to ward off migraine headaches and for arthritis, rheumatic disease, and allergies.
- Possible Side Effects: May increase bleeding, especially in patients already taking certain anticlotting medications..
Garlic
- Common uses: For lowering cholesterol, triglyceride levels, and blood pressure.
- Possible Side Effects: May increase bleeding, especially in patients already taking anticlotting medications.
Licorice
- Common uses: For treating stomach ulcers.
- Possible Side Effects: Certain licorice compounds may cause high blood pressure, swelling, or electrolyte imbalances.
Valerian
- Common uses: Mild sedative or sleep-aid; also a muscle relaxant.
- Possible Side Effects: May increase the effects of certain antiseizure medications or prolong the effects of certain anesthetic agents.
American Society of Anesthesiologists
Reprinted with permission of the American Society of Anesthesiologists, 520 N. Northwest Highway, Park Ridge, Illinois 60068-2573.
Date Published: 2000-08-30
7800 Wolf Trail Cove, Germantown, TN 38138
Phone: (901) 682-9222; Fax: (901) 682-9505