Herbal Supplements and Risks Before Surgery

Jim Crocker
15th April, 2024

Herbal Supplements and Risks Before Surgery

Image Source: Natural Science News, 2024

Key Findings

  • Many surgical patients in the U.S. don't tell their doctors about herbal medication use
  • Herbal medications can dangerously interact with anesthesia, affecting coagulation and vital systems
  • Improved patient-physician communication about herbal supplement use is crucial for safe surgery
The modern healthcare landscape is witnessing an intriguing phenomenon: the burgeoning use of herbal medications and supplements. In the United States alone, the retail sales of these products have soared, reaching a staggering $13 billion in 2021[1]. This trend towards alternative forms of medicine is not without its complications, especially when it comes to surgical care. At the heart of this issue is the interaction between herbal medications and conventional medical treatments. A recent study conducted by the Cedars-Sinai Medical Center sheds light on the prevalence of herbal medication use among preoperative patients, revealing a critical gap in patient-physician communication. According to their findings, a significant number of surgical patients—between 50 to 70 percent—do not inform their doctors about their herbal medication usage. This silent majority poses a hidden risk, as many of these natural products can have serious interactions with anesthetic medications used during surgery. Herbal medications like garlic, ginseng, ginkgo, St. John's wort, and echinacea are among the most commonly used by patients before undergoing surgery. The dangers of such undisclosed use are manifold. Herbal medications can affect the body's coagulation system, increasing the risk of bleeding, or impact the cardiovascular system, potentially leading to arrhythmias or blood pressure issues. Effects on the central nervous system can include sedation or confusion, while other systems such as pulmonary, renal, and endocrine-metabolic can also be affected, leading to complications like coughing, diuresis, or altered drug metabolism. This recent study echoes earlier research that has highlighted the widespread use of herbal supplements, particularly among certain demographics. For example, a 2015 survey found that herbal supplement use was associated with older age, higher education, and the presence of chronic diseases such as stroke, cancer, and arthritis[2]. These findings suggest that a significant portion of the population may be at risk of potential drug-herb interactions, especially in the context of surgical care. Regulatory aspects also play a role in this complex landscape. In the North American region, comprising the USA, Mexico, and Canada, the regulatory frameworks for herbal products differ significantly[3]. In the US, since the passage of the Dietary Supplement Health and Education Act (DSHEA) of 1994, herbal medications have been subject to less stringent regulation. This lack of oversight may contribute to the challenges faced in ensuring the safe use of these products in clinical settings. The use of complementary and alternative medicine (CAM), including herbal medications, is not a new phenomenon in the context of surgical care. A study from 1998 revealed that a high percentage of patients undergoing cardiac surgery used CAM, but few discussed it with their healthcare providers[4]. This reluctance to disclose CAM use to physicians has serious implications for patient safety, particularly when it comes to perioperative care. Moreover, a survey of elective noncardiac surgical patients in the San Francisco Bay Area found that nearly 40% used some form of alternative medicine supplements, with a significant number failing to consult their primary physicians or inform their anesthesiologists about this use[5]. This lack of communication is a critical issue, as it hinders the ability of healthcare professionals to anticipate and manage potential adverse interactions during surgery. The findings from the Cedars-Sinai Medical Center study and previous research underscore the need for a more proactive approach in the preoperative evaluation process. Anesthesiologists and other healthcare providers must be diligent in inquiring about the use of herbal medications to mitigate the risks of adverse drug interactions. Furthermore, patients need to be educated about the importance of disclosing all forms of medication use, including herbal supplements, to ensure their safety during surgical procedures. In summary, the growing use of herbal medications poses a unique challenge in surgical settings. It is imperative that both patients and healthcare providers work together to bridge the communication gap and ensure that the use of these products does not compromise the safety and efficacy of surgical care.



Main Study

1) Use of herbal medication in the perioperative period: Potential adverse drug interactions.

Published 12th April, 2024


Related Studies

2) Prevalence and Predictors of Herbal Medicine Use Among Adults in the United States.


3) Historical Aspects of Herbal Use and Comparison of Current Regulations of Herbal Products between Mexico, Canada and the United States of America.


4) Use of alternative medicine by patients undergoing cardiac surgery.

Journal: The Journal of thoracic and cardiovascular surgery, Issue: Vol 120, Issue 2, Aug 2000

5) The prevalence and predictors of the use of alternative medicine in presurgical patients in five California hospitals.

Journal: Anesthesia and analgesia, Issue: Vol 93, Issue 4, Oct 2001

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