Herbal Products: Dangerous During Surgery?

MINNEAPOLIS -- The popularity of herbal supplements as a supposed energy booster and remedy for minor illnesses continues to rise.

But herbs could be anything but helpful for surgery patients, according to a study published in Wednesday's issue of the Journal of the American Medical Association.

Common herbal supplements could cause serious side effects during and after surgery, say researchers from the Pritzker School of Medicine at the University of Chicago. They say that physicians should be aware of the potential side effects and should obtain a complete history of herbal supplement use from their patients before a scheduled surgery.

In the study, researchers identified commonly used herbal supplements based on 1999 sales data and surveys. The herbs analyzed included echinacea, ephedra, garlic, ginkgo, ginseng, kava, St. John's wort and valerian.

The authors then searched for and reviewed articles published between 1966 and 2000 on the safety, effectiveness and action of these herbs to determine their impact on surgery patients.

According to previous studies, possible complications from use of herbal supplements include heart attack, stroke, bleeding, increased or decreased effectiveness of anesthesia, organ transplant rejection and interference with other medications.

More than 5,000 suspected herb-related adverse reactions were reported to the World Health Organization before 1996, and 2,621 -- including 101 deaths -- were reported to the Food and Drug Administration between 1993 and 1998. The effects of some herbal supplements can linger two to three weeks after patients stop using them, according to the article.

In this study, researchers found that the eight herbs analyzed may pose a risk before or after surgery. Complications could include bleeding from garlic, ginkgo and ginseng; irregularities in heart rate from ephedra; and low blood sugar from ginseng. Possible results from kava and valerian interacting with drugs include a greater sedative effect of anesthetics. Possible effects of St. John's wort include increased metabolism of many drugs used in the period around an operation.

Twelve percent of the U.S. population uses herbal supplements, and 22 percent of patients scheduled for surgery reported using such medications, according to the article. The eight herbal supplements studied account for more than 50 percent of all single-herb preparations sold in the United States.

"Many practicing physicians remain unaware of potential ... complications of herbal medication use," the authors write. They say that physicians should be familiar with the effects of commonly used herbs so they will be prepared to prevent, recognize and treat potentially serious problems that may arise.

Doctors should also be familiar with all supplements a patient is taking -- whether they're conventional or herbal, the authors write.

A previous study found that more than 70 percent of patients failed to disclose their use of herbal supplements before an operation. Many patients believe that physicians are not knowledgeable about herbal supplements or are prejudiced against their use. Also, some patients would not consider these substances to be medications.

There is currently no mandatory reporting of adverse effects of herbal medication, as there is for conventional medication. The Dietary Supplement Health and Education Act of 1994 exempts herbal supplements from the safety and efficacy requirements of prescription and over-the-counter drugs. The FDA must show a product is unsafe before it can be removed from the market.

Complicating the matter is that the potency of herbal supplements varies from one manufacturer to the next, and many add heavy metals, pesticides and drugs to their products, according to the article.