Perioperative Herbs: What You Should & Shouldn't Take Before an Operation

The United States is a country whose citizens use dietary supplements to fill in the gaps in their health care. In a report cited in the September 2007 Archives of Pediatrics and Adolescent Medicine, almost 50 percent of adult males and almost 60 percent of adult females take a dietary supplement of some kind. Over one-third of American children eighteen years of age and younger are given dietary supplements. In recent years, surgeons, anesthesiologists, and others in the medical profession have begun to sound a warning about perioperative herbs and the patient about to have surgery.

Although no concerted large group studies have been documented, several case studies and anecdotal reports seem to indicate certain perioperative herbal supplements may be harmful.

What are perioperative herbal supplements?
The word 'perioperative' means the time period two or three weeks in duration before surgical procedures are performed. 'Herbal supplements' are additions to the diet sold generally over-the-counter in tablet, capsule, or liquid form. The active ingredients are taken from plants and plant derivatives.

What are the most popular herbal supplements and how are they used?
The April 23, 2003, issue of Critical Care Nurse lists the nine most taken perioperative herbal supplements. This is the list in order of their popularity:

Ginkgo biloba has long been regarded as an aid to combat memory loss due to getting older. It is also used for male impotence, dizziness, various ear and eye disorders like tinnitus (ringing in the ears) and glaucoma, and as an antioxidant. Ginkgo seems to increase blood circulation, especially to the brain, and is thought to combat arteriosclerosis, or hardening of the arteries.

Garlic has enjoyed a surge in popularity as an herbal supplement in recent years. It has been touted as a preventative against cancer, arteriosclerosis, and infections from fungus and bacteria. It is said to decrease high blood pressure, lower cholesterol and blood sugars and fight arthritic conditions and allergies.

Ginseng is taken as a stress reliever. It helps to increase mental alertness and energy levels while at the same time reducing cholesterol and preventing infections.

Mention the herbal supplement St. John's wort and many people might think of the claims made as to its role in treating depression, anxiety, and menopausal and sleep problems. It is used also to treat infections from bacteria and viruses.

The herbal supplement echinacea is taken by many as soon as cold symptoms are present. Echinacea works as a stimulant to the immune system and is believed to treat infections of many types including those from yeast and bacteria.

Saw palmetto is generally thought to be a sexual stimulant but is also used as an herbal supplement to treat prostate gland enlargement (hyperplasia) and to aid in building muscle.

Ephedra is one of the key herbal supplements that was used in the weight loss industry. It is considered in the amphetamine group of drugs and is illegal in the United States. Ephedra stimulates the nervous system.

The effects ephedra has on the nervous system is unlike the effects the herbal supplement valerian root has on the body. It is taken for sleep problems, anxiety, stress, and migraines. Valerian root relaxes the muscles so is used for muscle pain.

The herbal supplement kava kava, like valerian root and St. John's wort, is often taken to decrease anxiety and stress. It relaxes the muscles and reduces headache pain as well as aids in treating insomnia.

What are the current recommendations about perioperative herbal supplements?
Physicians, surgeons, and anesthesiologists want to know exactly what herbal supplements, prescribed medications, vitamins and minerals their patients are taking. The medical professional should receive a detailed list of everything the perioperative patient has taken in the past several months. If the patient is taking an herbal supplement which is known to have potential side effects during and after surgery, he will ask for the surgical patient to quit taking those supplements for two or three weeks before the operation. This gives the body an opportunity to cleanse itself of the supplement.

Some health drinks, cereals, and energy bars contain herbal supplements. If these are ingested on a regular basis, they should also be discontinued until after the surgery. Remember, the body must be cleansed of any traces of the herbal supplement before the operation.

Which herbal supplements may be dangerous to the perioperative patient and what are the potential dangers?
One of the biggest concerns during and after any surgical procedure is the risk of uncontrolled bleeding or hemorrhage. Some herbal supplements prevent the blood from coagulating properly. Of the nine listed above, garlic, ginseng, and ginkgo have these anticoagulant affects. Other herbal supplements known to cause this type of problem are ginger, fenugreek, feverfew, and evening primrose oil.

Some herbal supplements affect cardiovascular function during or after surgery. These include ephedra, ginseng, and St. John's wort, as well as cascara and lily-of-the-valley. Ginseng is known to raise blood pressure, while garlic is known to lower it. Some of these herbal supplements could increase the likelihood of cardiac arrest.

The third big concern during and after a surgical procedure is the interaction of herbal supplements with anesthetics and analgesics. Valerian root, St. John's wort, and kava kava could make the patient difficult to arouse from the anesthetic state. Echinacea and kava kava interact with the analgesic acetaminophen to increase its effects. Valerian root, kava kava, and chamomile interact with opioid pain relievers magnifying their effects. Ginseng decreases the effects of pain relievers.

Are there any perioperative herbal supplements that may be useful?
According to an article found on intactinfo.wordpress.com, some plastic surgeons in Beverly Hills, California, are prescribing herbal supplements like arnica montana, nux vomica, and grape seed extract to their perioperative patients. Arnica montana reduces bleeding and bruising. It, along with grape seed extract, seems to reduce inflammation and promote healing of tissues. Nux vomica is an herbal supplement given to reduce the bad side effects that anesthesia can sometimes give after surgery.

The best medical advice a patient can follow about perioperative herbal supplements is, if in doubt, stop taking them two to three weeks before the surgical procedure. Always disclose to your physician everything you take as a supplement.

Resources:
JAMA and Archives Journals. "Almost One-third Of US Children Regularly Take Dietary Supplements." ScienceDaily 2 October 2007. 5 September 2008 .
American Academy of Opthalmology Complementary Therapy Task Force. "Nutritional Supplements: Perioperative Implications for Eye Surgery." Catherine A. Heyneman. "Preoperative Considerations: Which Herbal Products Should Be Discontinued Before Surgery?" Critical Care Nurse 23 April 2003. http://ccn.aacnjournals.org/cgi/content/full/23/2/116
Carrie Carter. A Woman's Guide to Good Health. "Herbal Supplements: The Good, the Bad, the Ugly." http://www.cbn.com/health/nutrition/womansguide_herbal.aspx
"Nutritional Herbal Supplements for Plastic Surgery in Beverly Hills." 12 July 2008.
http://intactinfo.wordpress.com/2008/07/12/nutritional-herbal-supplements-for-plastic-surgery-in-beverly-hills/