Herbals, surgery and anesthesia don't always mix

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Herbals, surgery and anesthesia don't always mix

10-Sep-2004 News-Medical.Net

The woman who swears by gingko biloba wonders why her mouth won't stop

bleeding after wisdom tooth surgery. What she doesn't know is that the

herbal remedy she takes religiously to enhance mental alertness also

acts as a powerful blood thinner that inhibits clotting.

She never thought to mention gingko when her oral and maxillofacial

surgeon (OMS) asked her before surgery what medicines she takes. Gingko

is an herb and, therefore, harmless and not a medicine, right?

Not true. Mounting anecdotal and scientific evidence indicates that

gingko and other " natural " herbal remedies, including everything from

garlic tablets to green tea, can lead to unexpected, potentially harmful

side effects that can interfere with surgery and anesthesia, says Pamela

L. Alberto, DMD, who will speak at the American Association of Oral and

Maxillofacial Surgeons' annual meeting, September 29 - October 2, 2004,

in San Francisco, California.

The potential for problems are a concern for oral and maxillofacial

surgeons, who routinely administer anesthesia for surgeries that include

wisdom tooth extractions, dental implant placements and intricate facial

reconstructive procedures, according to Dr. Alberto, who is a clinical

associate professor and director of predoctoral surgery at the

University of Medicine and Dentistry of New Jersey.

" OMSs, like all doctors, are caring for a growing number of patients who

rely on herbal remedies as alternatives or complements to traditional

treatments for medical problems, " Dr. Alberto says. More than 60 million

Americans over the age of 18 use at least one herb-based product on a

regular basis, she notes.

" The phenomenal popularity of these substances underscores the need for

OMSs to learn more about them and their potential impact on patients.

Many of the patients we see are taking a slew of alternative remedies.

We have to know what they're on while they're under our care, " she says.

Herbals of particular concern to OMSs include those that can cause

drowsiness, excessive bleeding, cardiovascular problems or that

interfere with other drugs, Dr. Alberto says.

Garlic, ginseng, ginger, chamomile and gingko, among others, can cause

bleeding after surgery. Valerian root and kava may interact with

sedatives given by the OMS before surgery and produce excessive

drowsiness. St. 's Wort, used as a mood enhancer, can interfere with

the effectiveness of many heart and blood pressure medications and blood

thinners. Ginseng has been associated with an increased incidence of

arrhythmias (irregular heart beats). Patients who take ginseng and

receive local anesthesia with epinephrine may be putting themselves at

risk for cardiovascular complications. Echinacea, used widely to enhance

the immune system, may inhibit wound healing and increase the risk of

post-surgical infection.

To avoid these complications, " OMSs should make it standard practice to

ask patients specifically about herbals and other alternative remedies

when planning surgery and anesthesia care, " Dr. Alberto says, adding

that she takes a complete history of herbal use by the patients she

treats. Consumers tend to view herbal remedies as natural, and

therefore, safe from adverse effects and drug interactions, so they

often don't think to tell their doctor about them, she says.

" If we know a patient is taking a supplement that could cause problems,

we can ask them to stop taking it before surgery or modify the

anesthesia accordingly, " she says. At the same time, patients should

make sure to tell their doctor about all of the substances they are

taking, including herbal supplements, prescriptions and over-the-counter

drugs, she says.

The fact that herbals are classified as dietary supplements, not drugs,

means they are not regulated by the United States Food and Drug

Administration, Dr. Alberto adds. As a result, herbals vary greatly in

quality and quantity from manufacturer to manufacturer and from batch to

batch, so consumers can never be sure of what they're getting.

" The big problem is that there are herbal-drug interactions. Although

there are a lot of unknowns, as surgeons, it behooves us to know as much

about these products as we can, " she says.

The American Association of Oral and Maxillofacial Surgeons (AAOMS), the

professional organization representing more than 7,000 oral and

maxillofacial surgeons in the United States, supports its members'

ability to practice their specialty through education, research, and

advocacy. AAOMS members comply with rigorous continuing education

requirements and submit to periodic office examinations, ensuring the

public that all office procedures and personnel meet stringent national

standards.

http://www.aaoms.org/