X-SciTech

Herbal Cures And Surgery May Not Mix

By CBSNews.com staff CBSNews.com staff

July 10, 2001 / 5:14 PM EDT / CBS

Gingko biloba caused a gall bladder surgery patient to develop serious bleeding. Medicinal garlic caused spinal bleeding in another patient, who needed a second operation to avoid permanent paralysis.

Both are real-life examples of surgical complications that can develop from herbal medicines. They are cited by University of Chicago doctors who developed a list of recommendations on when to stop taking such products before an operation.

"We suspect that these cases represent only a small fraction of the actual adverse events related to herbal medications since there is no adequate reporting mechanism," said Drs. Michael Ang-Lee, Jonathan Moss and Chun-Su Yuan.

A University of Chicago survey found that up to 50 percent of pre-surgery patients there use herbal medicine, according to Yuan, and similar results have been found at other hospitals.

"Many herbs do have beneficial effects, but if patients don't have enough knowledge these herbs can cause adverse effects," Yuan said.

The researchers note that the American Society of Anesthesiologists recommends that all herbal medicines be stopped at least two to three weeks before surgery to avoid complications.

But the Chicago doctors say their review of medical literature suggests a more targeted approach.

Their recommendations, published in Wednesday's Journal of the American Medical Association, refer to eight commonly used products: echinacea, ephedra, garlic, gingko biloba, ginseng, kava, St. John's wort and valerian.

The popular herbal medicines - taken by an estimated 12 percent of Americans for conditions ranging from back pain to depression - may interact with drugs prescribed for surgery and prevent clotting or increase the potency of anesthetics, even if their use has been stopped days before, a report summarizing the findings of previous studies said.

Gingko biloba, for example, which has been used for age-related eye disease, impotence and altitude sickness, can raise the risk of bleeding. It should be discontinued at least 24 hours before surgery, the researchers said.

Ephedra can cause irregular heartbeat, ginseng may exacerbate low blood sugar, kava and valerian can exaggerate the impact of anesthetics, St. John's wort can speed up the metabolism, and echinacea poses a risk of poor wound healing and infection.

Garlic, which may lower blood pressure and cholesterol, also prevents clotting and should be discontinued at least 36 hours before surgery, the researchers said.

They encouraged patients to tell their physicians about any herbal products they may be taking and said doctors should aggressively question patients about their use of such products, especially before surgery.

Patients and physicians were often unaware of the risks, and some patients were hesitant to admit to their doctors they used herbal remedies, increasing the likelihood of serious complications, the report said. It drew its conclusions from studies and articles published o the subject since 1966 and examined the remedies' pharmacological effects.

"The prevention, recognition and treatment of complications begin with explicitly eliciting and documenting a history of herbal medicine use," the researchers said. "Clinicians also should recognize that discontinuation of all herbal medications before surgery may not free a patient from risks related to their use."