Herbal Meds: Why Your Anesthesiologist Should Know

• • Bleeding
  • Stroke
  • Heart Attack
  • Organ Toxicity
  • Electrolyte Problems
  • Prolonged Anesthesia

This list is not meant to scare you. It’s not to suggest this will happen to you, if you are taking supplements. But the use of herbal products has been linked to the above complications (including death).

What is important is to let your anesthesiologist know what you are taking. Treat these supplements just like you would any traditional medicines you are taking, and get this information to your anesthesiologist.

We’ll cover some of the popular herbal products below and what sort of side effects or complications are associated with them. This list is by no means exhaustive and does not include all possible effects. It is meant to give you an idea of their implications and why it’s important to have this conversation with your anesthesiologist before surgery.

Ephedra
One of the most widely known supplements used for weight loss, increased energy, and asthma prior to its ban in the US in 2004. It has both stimulant and thermogenic properties: it stimulates brain activity, increases blood pressure, increases heart rate, increases metabolism and heat production. As such, has been linked to heart attacks, strokes, and fatal arrhythmias.

Dong Quai (Angelica Sinensis)
Often prescribed for relief of menstrual cramps or menopausal symptoms; aka female ginseng. Contains 6 warfarin derivatives (a blood thinner) and antagonizes Vitamin K activity. Rare cases of liver toxicity have been reported.

Echinacea
Widespread use against infection and thought to relieve the severity and duration of the common cold. Also thought to stimulate immune function. This is the herb most commonly associated with anaphylaxis, a severe allergic reaction that affects multiple organ systems and can be life threatening. It may also cause organ rejection in patients that are transplant recipients.

The 3 G’s: Garlic, Ginseng, & Ginkgo Biloba
Though they may be taken for different reasons, all three are associated with a risk for increased bleeding (especially if taken in larger doses).

Kava
Used for it’s anti-anxiety and sedative properties. Can prolong general anesthesia, and is associated with liver and kidney toxicity.

St. John’s Wort
Used in the treatment of mild and moderate depression, with a mechanism of action that’s similar to the selective serotonin-releasing drugs. Interferes with drug metabolism by affecting liver enzymes (cytochrome p450 system). It can also cause central serotonin syndrome, a very dangerous and potentially life-threatening drug reaction.

Chondroitin
Can prolong bleeding

S-adenosyl-methionine (SAM-e)
May cause serotonin syndrome when combined with Meperidine (Demerol) or Tramadol (Ultram). Meperidine is an opioid (same drug class as morphine) that is used in the perioperative period to treat pain or shivering.

Coenzyme Q10aa
Has a structure similar to Vitamin K, and may interfere with warfarin (blood thinner) activity.

Fish Oil
Also associated with increased risk of bleeding, especially when taken in larger doses.

As you have seen just from this non-complete list of supplements, these alternative medicines can impact your anesthesia and your surgery. As of this writing, The American Society of Anesthesiologists recommends discontinuing all herbal medicines 2 to 3 weeks before elective surgery. Some additional information to provide your anesthesiologist includes where your herbs were manufactured and what kind of doses you are taking.

Your anesthesiologist is your advocate and caretaker during the surgical period. He/she is not there to judge you on the merits of alternative medicines. But we are interested in taking the best possible care of you. By providing us with this information, you give us the chance to provide you with the best possible perioperative experience.