Herbal remedies linked to perioperative complications

סקירה זו באדיבות אתר מדיקונטקסט: WESTPORT, CT (Reuters Health) – Commonly used herbal medications can often create problems during the perioperative period and physicians need to be familiar with the potential side effects and question patients specifically about their use, according to a review article in the July 11th issue of The Journal of the American Medical Association.

Dr. Chun-Su Yuan and colleagues, from the University of Chicago, searched MEDLINE and Cochrane Collaboration databases for research published from January 1966 to December 2000 referencing herbal medicine, phytotherapy, and alternative medicine. Data on eight commonly used herbal medications were extracted and analyzed to determine potential perioperative effects.

The authors identified several direct, pharmacodynamic and pharmacokinetic effects associated with the herbs. Garlic and ginkgo were linked to bleeding, ginseng was associated with bleeding and hypoglycemia, and ephedra was tied to cardiovascular instability, the investigators report. Kava and valerian potentiated the sedative effects of anesthetics and St. John's wort increased the metabolism of many perioperative drugs.

"Because most patients may not volunteer that they are taking herbal medications in the preoperative evaluation, physicians should specifically elicit and document a history of herbal medication use," the researchers emphasize.

"Although there has been initiation of herbal medicine into medical school curricula at several institutions many practicing physicians remain unaware of potential perioperative complications of herbal medication use," the authors point out. "This information is necessary to prevent, recognize, and treat potentially serious problems associated with herbal medications, taken alone or in conjunction with conventional medications."

JAMA 2001;286:208-216.

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