Herbs include flowering plants, shrubs, trees, moss,
fern, algae, seaweed, or fungus.
Recently, an
increased number of people have turned to herbal remedies for a number of
reasons. In
1997, U.S. adults spent more than $3.5 billion on herbal products and billions
more on
vitamins, minerals and other dietary supplements. This number has increased to
$14 billion in
the year 2000. One in five individuals who takes prescription medications
also takes
herbal preparations, high-dose megavitamins, or both. Eisenberg et al.,
estimate that 15
million people who take herbal medicine may be at risk for potential
adverse
interactions between their prescription medications and these products.
(JAMA.
1998;
280:1569-1575.)
Frighteningly,
the production and marketing of the majority of alternative medicines is
unregulated and
the companies are not required to demonstrate safety, efficacy or quality
in the same
manner as prescription medicines. This is due to the fact that herbal
medications were
classified as dietary supplements in the Dietary Supplement Health and
Education Act of
1994.
Currently, there
is an inconsistency in safety guidelines for manufacturing, labeling,
promotion of
health claims, and potency and purity of compounding. Herbal medications
cannot gain
patent rights and, as such, they are not termed “drugs.” The FDA can
“suggest” but
cannot require the herbal industry to provide scientific data to its
consumers.
Polypharmacy and
physiological alterations that occur during the perioperative period
may cause
morbidity and mortality associated with herbal medications. Perioperative
complications
that may occur include increased blood pressure, myocardial infarction,
stroke,
increased risk of bleeding, prolonged anesthesia, organ transplant rejection,
and
interference
with many medications. (JAMA. 2001;286:208-216.)
Use of herbal
medications is not necessarily a contraindication for anesthesia.
Pending more
definitive studies and in the best interest of patient safety, ASA is taking a
leading role in
educating the physician as well as the patient about the importance of a
thorough history
of a patient’s medication use. Patients should tell their physicians and
physicians
should ask about all herbal, dietary or other over-the-counter preparations as
well as
prescription medicine that the patient is taking.