Eight herbal medications pose potential dangers in surgical patients. (Discontinuation Before Surgery Needed).

BIG SKY, MONT. -- Eight herbal medications each may have a significant impact on patients undergoing surgery.

Results from a 1997 survey indicated that 12% of people in the United States used herbal medications, and recent survey results from people who were undergoing surgery indicated that in this group the fraction may be as high as 22% or 32%.

Eight herbal medications can be singled out because, as a group, they account for more than half of the single-herb preparations sold in the United States, even though more than 1,500 different preparations are on the U.S. market, Dr. Eric J. Bieber said at a meeting on gynecology gynecologic oncology and reproductive endocrinology.

Although herbal preparations are widely used by patients who undergo surgery in hospitals or as outpatients, it's been estimated that more than 70% of patients fail to disclose their use of herbal medicine during routine preoperative assessments. As a result, physicians need to specifically elicit and document a patient's history of using herbal medications, said Dr. Bieber, chairman of the division of ob.gyn. at the Geisinger Health System in Danville, Pa.

Dr. Bieber, who coedited the "Textbook of Complementary and Alternative Medicine" (Boca Raton: Parthenon, 2002), summarized some of the relevant effects that each of these eight commonly used herbal medications have in surgical patients:

* Echinacea. This agent is immunostimulatory with short-term use, so it should be avoided by patients who need perioperative immunosuppression. When used for more than 8 weeks, echinacea has the potential to cause immunosuppression, which in theory can lead to postsurgical complications, including impaired wound healing and opportunistic infections. Echinacea use also has been associated with allergic reactions, so it should be used with caution by patients with asthma, atopy or allergic rhinitis. The herb should be used with caution by patients with liver dysfunction because of concerns that it can cause hepatotoxicity. The potential for hepatotoxicity is another reason to stop use far in advance of scheduled surgery.

* Ephedra. This herb causes dose-dependent increases in heart rate and blood pressure. It also causes vasoconstriction and, in some cases, vasospasm of coronary and cerebral arteries that may lead to myocardial infarction and thrombotic stroke. Patients who use ephedra and are later anesthetized with halothane may be at risk of developing ventricular arrhythmias. Ephedra can also affect cardiovascular function by causing hypersensitivity myocarditis. Long-term use can cause tachyphylaxis by depleting catecholamine stores, which can contribute to perioperative bradycardia instability. Concurrent use of ephedra ...