Herbal Supplements

Question 1

Garlic

Answer 1

• inhibits platelet aggregation
• can increase the risk of perioperative bleeding, especially if the patient is taking other anticoagulants or NSAIDs.
• recommended that garlic be discontinued 1 week before surgery due to potential for irreversible inhibition of platelet function.

Question 2

Valerian

Answer 2

• Used to assist in sleep
• potentiates benzodiazepine effect
• Abrupt discontinuation can lead to a withdrawal syndrome similar to that associated with chronic benzodiazepine use.
• Suggested that valerian be tapered over several weeks.
• If tapering is not possible, it should not be discontinued until the day before surgery.

Question 3

Herbal supplements that increase the risk of bleeding:

Answer 3

garlic
gingko
ginseng
ginger
saw palmetto

Question 4

Saw palmetto

Answer 4

• Used to treat symptoms associated with BPH
• Has been associated with excessive intraoperative bleeding
• attributed to its anti-inflammatory effects and platelet dysfunction.

Question 5

St John’s Wort

Answer 5

• Used to treat mild to moderate depression.
• Believed to be a MAOi and inhibits the reuptake of monoamines.
• A Cyp2c19 inducer and can prolong effects of anesthesia
• Can prolong the effect of clopidogrel in nonresponders
• Reduces the effect of warfarin and heparin

Question 6

Gingko biloba

Answer 6

Associated with excess bleeding. Contains compounds that alter vasoregulation, act as antioxidants, modulate neurotransmitter and receptor activity, and INHIBIT platelet activating factor.

Question 7

Ginger

Answer 7

Has been used to treat nausea, but has antiplatelet effects and may cause perioperative bleeding, especially when combined with aspirin or NSAIDs.

Question 8

Kava

Answer 8

An anxiolytic or sedative widely used as a CNS depressant, potentiates the effects of benzos and may prolong effects of anesthesia

Question 9

Ginseng

Answer 9

Decreases postprandial glucose levels and can cause hypoglycemia, potentially irreversible effect on platelets

Question 10

Ephedra

Answer 10

Stimulant and bronchodilator, dose dependent increase in HR and BP