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DON'T TAKE HERBAL MEDICATION PRE-SURGERY
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People who take herbal medicines in the weeks before surgery are at risk of
cardiovascular instability, blood pressure problems, and excess bleeding, according to a speaker at a conference of the Australian and New Zealand College of Anaesthetists.
Dr Penelope Hodges, from the anaesthetics department of Royal North Shore Hospital in Sydney, said increasing numbers of patients are using herbal medicines such as echinacea, garlic, gingko biloba, ginseng, St John's wort, valerian, ephedra, kava, grapefruit juice, and ginger.
Although these herbal medications are "natural" products with known and potential benefits, adverse effects are associated with their use, she said.
"These adverse effects include interactions between herbal medicines and conventional drugs, pharmacodynamic effects such as increased bleeding tendency, and interaction with anaesthetic agents in the perioperative period."
There have been case reports of increased heart rate and high blood pressure associated with ginseng and ephedra (the latter is not available in Australia), she said.
And there are several reports of unexpected bleeding associated with garlic and gingko biloba.
"This is not surprising as it has been shown that both have anti-platelet action.
"In the nonsurgical population this is probably a good thing because we already recommend that people with heart disease take aspirin, but the perioperative period is a good time to stop because of the risk of unexpected surgical bleeding."
Dr Hodges said prolonged anaesthesia may occur if people take kava or valerian, which are known sedatives and anti-anxiety products.
Echinacea is an immunostimulant but if people are taking it regularly or for long periods then it can become an immunosuppressant, so there could be an increased chance of wound infection or poor wound healing, she said.
"I looked at 10 herbal medicines and some of them have been shown to have benefits - so it is not a matter of saying we should not be taking herbal medicines.
"Rather it is in the perioperative period that people should stop them."
Dr Hodges recommended that patients tell their doctors about any herbal medications they are taking if the are to undergo surgery.
Moreover, doctors must become familiar with the basic information about herbal medicines and include in their preoperative assessment of a patient a specific enquiry of herbal medicine use, she said.
Current guidelines suggest that all herbal medicines should be ceased two weeks prior to surgery.
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