Herbs and surgery can be a dangerous mix

While herbal remedies are generally regarded as safe, many have evidence of actions or interactions of concern for patients undergoing surgery.
By John Russo Jr./Vicus.com

VICUS.COM (28 Sept. 2000) — A 62-year-old woman was admitted to the hospital for elective cardiovascular surgery. As part of the presurgical workup, the surgeon asked if she was taking any medicines. She replied that she was not. The surgeon then asked if she was taking any herbal supplements or vitamins, to which she listed 12 herbal remedies that were part of her daily self-medication routine.

Concerned that one or more of these herbals might increase her risk of bleeding during the operation, the surgeon ordered laboratory tests to determine her bleeding time. The results showed that, in fact, her bleeding times were prolonged. As a result, surgery was postponed for two weeks, and the patient was advised to discontinue all herbal medicines during this time.

Upon returning to the hospital, her bleeding times were normal and the surgery was performed without complications. She was discharged and started to take the herbal medicines again. Four weeks later, she went to the emergency room complaining of repeated blood loss from her nose.

Probing to uncover herbal medicine use

According to the American Botanical Council, almost one-third of all American adults (almost 60 million people) use herbal products. And there is evidence that when people are diagnosed with a specific disease, their interest, as well as their intake of herbal medicines and nutraceuticals, increases.

In fact, people all over the world are increasingly concerned about the harm inflicted by modern, technological medicine, especially pharmaceuticals, and the high cost of these treatments. Many patients are finding that herbs can have actions similar to those of herb-derived drugs, without drug side effects (Pelletier, 2000).

Unfortunately, using a questionnaire or asking general questions does not reliably uncover the use of these medications. A 1999 survey conducted at the Scott & White Memorial Hospital in Temple, Texas, found that among 979 presurgical patients, 170 (17.4%) reported taking such products. Although this is a significant number of patients, it is well below the national average.

When conducting a presurgical medication interview, it is important to recognize that patients often consider herbal remedies to be natural, and therefore, free from side effects or drug interactions. Just as people often limit the word “medicine” to mean prescription drugs, rather than over-the-counter drugs, patients may not recognize that an herbal remedy is also a “medicine.”

The key is for the surgeon, anesthesiologist, nurse or other health-care practitioner to probe and modify questions in a way that will help patients understand exactly the information being sought.

Remedies of special interest in surgical patients

See the accompanying table.

At the time of this study, Charles McLeskey, M.D., was professor and chairman of the Department of Anesthesiology at the Scott & White Hospital and Clinic. He said he believes that among herbal medications, three areas are of special concern to surgeons and anesthesiologists: herbals that may predispose the patient to anticoagulation abnormalities, cardiovascular complications and sedative effects during and following surgery.

Surprisingly, although herbal remedies are generally regarded as safe, many have potential for or evidence of actions or interactions of concern to patients undergoing surgery. The table (Red flags in drug-herb interaction) lists some of the more commonly used herbal remedies that may be associated with three areas of concern for patients undergoing surgery: coagulation abnormalities, cardiovascular complications and sedative effects. 

John Russo Jr., PharmD, is senior vice president of medical communications at Vicus.com. He is a pharmacist and medical writer with more than 20 years of experience in medical education. 

This article was updated on 28 Sept. 2000.  

American Botanical Council: http://www.herbalgram.org American Society of Anesthesiologists:
http://www.asahq.org/homepageie.html Dermarderosian A. Guide to Popular Natural Products. St. Louis (MO): Facts and Comparisons; 1999. Izzat MB, Yim AP, El-Zufari MH. A taste of Chinese medicine! Ann Thorac Surg. 1998 Sep; 66(3):941-2. 

Ko R. Adverse reactions to watch for in patients using herbal remedies. West J Med. 1999 Sep; 171(3):181-6. 

Larkin M. Surgery patients at risk for herb-anaesthesia interactions. Lancet. 1999 Oct 16; 354(9187):1362. 

McLeskey CH, et al. The incidence of herbal and selected nutraceutical use in surgical patients [abstract]. American Society of Anesthesiologists Annual Meeting, Dallas, Texas, October 1999. 

Miller LG. Herbal medicinals: Selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med. 1998; 158(20):2200-2211.

Pelletier KR. The Best Alternative Medicine. What Works? What Does Not? New York (NY): Simon & Schuster; 2000.