What is the most popular herbal remedy used in the U.S., and what is it for?
Echinacea… To improve immune system through modulation of cytokine signaling… Treatment of viral, bacterial, and fungal infections (most common for respiratory infection)
What is the name of a supplement used for weight loss or CNS stimulation that can result in palpitations, HTN, tachycardia, stroke, seizures, cardiomyopathy, MI, dysrhythmias, psychosis, acute hepatitis, and even death?
What are some anesthetic considerations/contraindications for patients taking Ephedra?
When used with other sympathomimetic drugs it can cause life threatening dysrhythmias, HTN, and hyperthermia… May deplete endogenous catecholamine stores leading to further cardio instability and tachyphylaxis to other sympathomimetic drugs (like ephedrine)…. May need to use direct acting
What is contained in Ephedra and what affect does it have on cells?
Alkaloids ephedrine (primary compound), pseudoephedrine, methylephedrine, and nor-pseudoephedrine…. Direct agonist effect on alpha and beta receptors… Can also indirectly increase presynaptic neuronal release of norepinephrine
What is garlic supplement used for and what are some possible anesthetic considerations?
Tx of cardiovascular disease, diabetes, infection, and tumors…cysteine in garlic is believed to decrease thromboxane formation and alter arachidonic acid metabolism… Can potentiate anti platelet effects of NSAIDs and aspirin… So assess bleeding risk and discontinue 7 days prior to surgery
What is ginger used for…. How is it proposed to work… And what are some possible anesthetic considerations?
Prevent motion and morning sickness…. arthritis… Variety of GI symptoms… Inhibit thromboxane synthesis, decreasing platelet aggregation… Assess bleed risk and do not use with other anticoagulants
What are the main uses of ginkgo biloba and how is it suspected to work?
Decrease blood viscosity and improve blood flow to tissues as needed for treatment in PVD… Protect vascular walls and nerve cells by acting as a free radical scavenger and inhibit platelet activating factor
What are some anesthetic considerations for patients taking gingko biloba and when should it be stopped prior to surgery?
Assess for bleeding… Avoid with other anticoagulants… Discontinue 36 hours before surgery
What is the most expensive herb worldwide that is used for immunomodulation, mood enhancement, & aphrodisiac effects?
What are some anesthetic considerations for ginseng?
Assess bleeding risk d/t inhibition of platelet aggregation… Check blood glucose, especially if on hypoglycemics because it can also have a hypoglycemic effect… It has a mild sympathomimetic effect and may interact with monoamine oxidase enzyme (tremors and mania)… May irreversibly inhibit platelet aggregation so must d/c 7 days before surgery (life of a platelet)
What are possible clinical complications that can result from the use of Echinacea?
Immunosuppression and hepatic failure…avoid hepatotoxic drugs and use in patients who require peri operative immunosuppressive therapy
What herbal supplements play a role in inhibiting the aggregation of platelets?
Some herbal medicines such as ginkgo biloba, ginseng, St John’s wort and garlic are thought to impair platelet aggregation through reducing available intracellular calcium. They can increase the risk of bleeding with anticoagulants.