|
Herbal Medicines: Current Trends in Anesthesiology Practice - A Hospital Survey
By: Dr. Adam Kaye, A.D. Kaye, R.C. Clarke, R. Sabar, S. Vig, K.P. Dhawan, R. Hofbauer |
Introduction
There has been a significant increase in the proliferation and use of dietary supplements including nutraceuticals over the past two decades. Nutraceuticals include all herbal medications, medicinal foods, and vitamins. Although herbal products are neither prescribed nor often recommended by traditional health care providers, patients seeking conventional and unconventional health care are more commonly using these over-the-counter substances. There are more than 29,000 herbal and related substances presently used or available for consumption in the United States.1 The majority of patients do not reveal their use of herbs to their health care providers. In part, patients often consider the herbs to be mere supplements and not constituting drugs or other forms of medicine. When presenting for surgical procedures, such patients may pose a considerable challenge or risk for anesthesiologists in unexpected anesthetic responses during surgery.2,3 To date, there are no data on the incidence and prevalence of herbal and dietary supplemental use among surgical patients. To address this problem, we administered a survey to 1,017 patients presenting for preanesthetic evaluation in the outpatient clinic of the Department of Anesthesiology at the Texas Tech University Health Sciences Center in Lubbock, Texas.
The purpose of this study was to create awareness among clinical anesthesiologists regarding the use of herbal medicines by patients presenting for a preanesthetic evaluation. As some of these herbs are known to cause unexplained and potentially serious intraoperative hemodynamic alterations, increased bleeding tendencies, and other herb-anesthetic interactions, it becomes prudent for the anesthesiologist to possess a reasonable knowledge and an understanding of these important agents.
Materials and Methods
The herbal survey was developed on the basis of a market study involving leading pharmacies and health stores. An inquiry into the names of the most commonly sold herbal products was performed and the most commonly used herbal products/constituents were then incorporated into the study survey.After approval by the Institutional Review Board at Texas Tech University Medical Center, Lubbock, Texas, the nutraceutical survey was administered. Patients were first evaluated preoperatively by members of the anesthesiology faculty and the resident staff at Texas Tech University Health Sciences Center, Lubbock. Patients under 18 years of age, patients undergoing emergency surgical procedures, or patients presenting for a repeated surgery during the 5-month survey period, were excluded from the study. The anesthesiology faculty members and residents were formally trained to administer the survey to these patients according to a set protocol. On completion of each preanesthetic evaluation, patients were administered the survey (Figure 1) to determine their usage of herbal medicines and related dietary supplements, including multivitamins. As part of each preanesthetic evaluation patients were asked if they were taking any medications or drugs. The number of patients who responded no to this question who were actually taking vitamins or herbal products was also determined. A list of the nine most popular nutraceuticals available over-the-counter (based on our market study of the leading health stores and pharmacies) was included in the survey, and each patient was then asked to circle on the survey the self-administered herbal products. The use of nutraceuticals was then reported in the preanesthetic assessment record of the patient.
The anesthesiology faculty and resident staff administered a total of 1,017 surveys. The survey period extended from May, 1999 to October 1999. Of the 1,017 patients surveyed, 262 surveys had to be discarded due to poor reporting by the patients. The remaining 755 surveys were valid in terms of their utilization to assess the prevalence of herb use in our patient population. A total of 482 patients admitted to be actively taking at least one or more dietary supplement. The remaining 273 patients reported no use of any herbal or related product.
Results
Dr. Adam Kaye, is a California Licensed Pharmacist and a Clinical Associate Professor of Pharmacy Practice at University of the Pacific's Thomas J. Long School of Pharmacy. He has also been employed by a national pharmacy company since 1992 and has served as a Pharmacy Manager since 1997.
©Copyright - All Rights Reserved
DO NOT REPRODUCE WITHOUT WRITTEN PERMISSION BY AUTHOR.
