© Springer Science+Business Media New York 2015
Paul K. Sikka, Shawn T. Beaman and James A. Street (eds.)Basic Clinical Anesthesia10.1007/978-1-4939-1737-2_5353. Alternative Medicine and Anesthesia
(1)
Department of Anesthesiology, Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
(2)
Department of Anesthesiology, Magee-Women’s, Hospital of UPMC, 300 Halket Street, Pittsburgh, PA 15213, USA
Keywords
Alternative medicineDietary supplementsVitaminsDrug interactionsPlatelet inhibitionComplementary and alternative medicine (CAM) is gaining increasing popularity across the United States. A 2007 survey found that approximately 38 % of the general adult population uses some form of complementary and alternative therapies. Almost 58 % of surgical patients use some form of CAM, with over 20 % using herbal or vitamin supplements. With such a wide-spanning influence, it is easy to see why knowledge of CAM may be important to the anesthesiologist.
A comprehensive definition of CAM is difficult to ascertain, as it is continually evolving and changing. The National Center for Complementary and Alternative Medicine (NCCAM), part of the National Institutes of Health, defines CAM as “a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine.” There are no official guidelines regarding perioperative use and discontinuation of herbal supplements, but the American Society of Anesthesiologists suggests that many herbal medications should be stopped 2–3 weeks prior to surgery.
Commonly Used Herbal Medicines
Echinacea
Echinacea (coneflower, purple coneflower) is used for prevention or treatment of common viral and/or bacterial infections, specifically of the upper respiratory tract. It is postulated to work by an immunostimulatory effect. Allergic reactions after echinacea use have been reported, including documented anaphylaxis. Patients with asthma or allergic sequelae should avoid the use of echinacea. Echinacea may interact with immunosuppressive drugs (via inhibition of cytochrome P450 system) necessary for patients with organ transplant and, therefore, should be avoided in this patient population too.
Ephedra
Ephedra (ma huang) use is common in Chinese medicine. It is used as a weight loss adjunct, to increase energy, and to treat upper respiratory symptoms, asthma, flu, and headaches. It was banned by the Federal Drug Administration (FDA) in 2004, as a result of reports of cardiovascular complications and death. The main cardiovascular effects of ephedra are mediated by its most active compound ephedrine, a sympathomimetic compound with alpha-1, beta-1, and beta-2 activity. The effects of ephedrine are an increase in heart rate and blood pressure.
Use of ephedra preoperatively by patients may result in tachyphylaxis due to depletion of catecholamines. In this situation, the use of direct-acting vasopressors is necessary. In addition, the interaction of ephedra and monoamine oxidase inhibitors may lead to a life-threatening hypertensive reaction.
Garlic
Garlic has been extensively studied for its benefits in patients with atherosclerotic disease. A meta-analysis showed that garlic may reduce blood pressure (vasodilation) and cholesterol levels. In addition, garlic has effects on platelets, inhibiting platelet aggregation with possible irreversible effects. Due to this effect, it is recommended that patients taking garlic discontinue usage at least 7 days prior to surgery.
Ginkgo
The leaf of the Ginkgo biloba tree has been used for thousands of years as a medicinal adjunct. Currently, interest in ginkgo to prevent/treat cognitive dysfunction is high. However, the Ginkgo Evaluation of Memory study found no improvement in cognitive decline and no change in the incidence of dementia and Alzheimer’s disease in elderly patients taking ginkgo. Ginkgo has also been used for treating symptoms of intermittent claudication. Ginkgo appears to inhibit platelet-activating factor, and therefore, it may increase perioperative bleeding risk.
Ginseng
Ginseng is an herb that has a variety of physiologic effects that are incompletely understood. Both American ginseng and Asian ginseng are commonly marketed. The active chemical compounds are ginsengosides. Ginseng may lower blood glucose and has been used for this effect. In addition, ginsengosides may alter coagulation parameters, and therefore, it is recommended that ginseng be discontinued at least 7 days prior to surgery.
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