Two independent studies conducted by anesthesiologists are providing some of the first evidence specifically associated with surgical complications and the prolonged use or sudden discontinuation of "alternative" medicines. Often available over the counter, they include herbal remedies, dietary supplements (nutraceuticals), and megavitamins, according to a report to the American Society of Anesthesiologists.
Specialists at M.D. Anderson Cancer Center, Houston, Tex., presented the case of a 37-year-old Chinese man who experienced severe, unexplained internal bleeding near the brain and vocal cords following surgeries to remove a cancerous neck tumor and, later, to restore the use of his vocal cords. A workup by a team of experts revealed that these serious complications could only have been triggered by the patient's long-term consumption of ginseng tea. The patient had not reported his ginseng use before surgery, but his wife mentioned it in passing after the operation. He survived the surgery, but required three additional emergency procedures to manage the severe bleeding.
"We know that ginseng has properties that can interfere with blood clotting, which is why the herb should not be taken with aspirin and other drugs that can affect clotting," points out anesthesiologist Jessie A. Leak. "Now, we have the first case report of serious postsurgical bleeding associated with longtime use of this herb." The incident emphasizes the need for consumers to understand that herbal remedies carry risks. She urges all patients to report their use of these substances in any form (fresh, tablets, teas, vinegar, suppositories, creams, etc.) to anesthesiologists and surgeons before surgery.
Nutraceuticals can have side effects when taken alone or when combined with prescription and over-the-counter (OTC) medicines and anesthesia, cautions Mary Ann Vann, an anesthesiologist and researcher at Beth Israel Deaconess Medical Center, Boston, Mass. A survey of 154 surgical patients revealed that 67% reported using alternative medicines, including vitamins, supplements, and herbal remedies. Vitamins E, C, and B, along with calcium, zinc, glucosamine, and selenium, headed the list of most common vitamins and supplements used.
The most commonly reported herbals included echinacea, garlic, St. John's wort, ginger, and ginkgo. In addition, 19% used herbs and vitamins or supplements; 12% took OTC drugs in addition to herbs, vitamins, and/or supplements; 12% took prescription drugs in addition to herbs, vitamins, and/or supplements; and eight percent reported concurrent use of all four categories of drugs: prescription, OTC, herbs, and vitamins or supplements. Fifty-eight percent reported recent OTC use, and 40% said they took both OTC and prescription drugs.
"The risk of drug interactions is very high while under anesthesia, and the risk of complications rises exponentially with the number of drugs a patient receives," Vann explains. "Given that even routine anesthetic care before, during, and after surgery can involve the administration of many drugs, the use of these additional substances may increase the risk of dangerous interactions."
Of the 79 patients taking alternative medicines, 16% discontinued use of at least one product before surgery, and none began taking any products in preparation for surgery. …