Doctors warn
of herbal medicines
before surgery

Anesthesiologists say such products
can adversely affect clotting ability,
heart rate or blood pressure

By Helen Altonn
Star-Bulletin

People using natural or herbal medications are cautioned to stop taking them two to three weeks before any surgery.

Dr. Della Lin, chief of anesthesiology at the Queen's Medical Center, reinforced a warning issued by the American Society of Anesthesiologists.

"Part of the problem is, there are so many people taking so many things, and they don't always think of herbal medicine or vitamins as a drug," she said.

Anesthesiologists usually ask patients what drugs they're taking, but they don't automatically volunteer information about an herbal medicine, Lin said.

"It's not because they're hiding it, but they don't think of it as a drug. They think of drugs as things they get prescriptions for."

Yet many natural herbs have potent properties, she said.

For example, she said, St. John's wort, used to treat anxiety, depression and sleep disorders, can cause a dramatic drop in blood pressure under anesthesia.

Ginkgo biloba, used to improve memory and increase blood circulation, also may reduce platelets needed for blood to clot, Lin said.

"If you're having large surgery, you need clotting ability to repair your body."

Ginseng, another popular herbal product believed to increase vitality, may raise the heart rate and blood pressure -- effects that may be compounded with anesthesia, Lin said.

No FDA control on potency

Americans are expected to spend about $5 billion this year on herbal medicines, the American Society of Anesthesiologists said.

Use of such products grew by 60 percent in one year, and they aren't subject to Food and Drug Administration testing like prescription drugs, the society pointed out.

It has not taken a formal position on the therapeutic properties of herbal medications.

"All we want to do is make the public aware that these products could pose a serious health risk if they are taken prior to surgery," said ASA President John B. Neeld Jr.

Lin said, "Some herbal medications are stronger and some weaker. We don't know which are stronger or weaker. There is no FDA control on the potency of the medicine."

Anesthesiologists have been learning about natural medications from places such as Germany, where there is more control over them, she said.

"Some medications have pretty dramatic changes either to a patient's blood pressure or heart rate or ability to clot under surgery."

If blood pressure is too high, a patient may risk having a stroke; if it's too low, the patient may have a heart attack or go into shock, she said. "There can be pretty significant outcomes if we don't get the entire information of a patient's history."

Several deaths occurred in California when patients using the diet drug fen-phen were under anesthesia, Lin said. That was before the drug was pulled off the market because of heart valve questions, she said. Half of the fen-phen combination -- fenfluramine -- was withdrawn in September 1997 after dozens of cases of a rare heart valve defect were detected in women who took fen-phen.

Compounding interactions could occur under anesthesia from using things such as Dexatrim or aspirin on a chronic basis, Lin said. Surgeons usually tell patients to stop using aspirin before surgery, she said.

"For herbal products, the information is just not out there. Even physicians are not aware of it. ... You don't want surgery canceled at the last minute when the surgeon realizes you're on something. That could be harmful."

The body usually normalizes itself if herbal medications are stopped two to three weeks before surgery, Lin said.

If there isn't enough time to stop the medication, patients should take the product in its container to the hospital so the anesthesiologist can see what the ingredients are.

Therapies can complement

Patients often withhold information from their doctors about using herbal products because they are considered alternative care, Lin said.

"Unfortunately, there seems to be a line drawn in the sand -- this is Western medicine, or Eastern, or alternative medicine. There is growing understanding that we need to come together and do rigorous research on integrative or complementary therapies."

When patients ask her what she thinks about certain medicines, she does fine on Western medicine, Lin said.

"I can't do that with a lot of complementary therapies. It's more on the anecdotal side.

"We have to find a middle ground where we can study these things on a fair basis, where they fit in best. ... We have to educate everybody -- patients, physicians and those providing complementary care."