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EDITORIAL
Year : 2007  |  Volume : 51  |  Issue : 3  |  Page : 167-168  

Clinical considerations of alternative medicine


Editor, IJA, India

Date of Web Publication20-Mar-2010

Correspondence Address:
Pramila Bajaj
Editor, IJA
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Bajaj P. Clinical considerations of alternative medicine. Indian J Anaesth 2007;51:167-8

How to cite this URL:
Bajaj P. Clinical considerations of alternative medicine. Indian J Anaesth [serial online] 2007 [cited 2019 Jul 16];51:167-8. Available from: http://www.ijaweb.org/text.asp?2007/51/3/167/61137

Alternative medicine is a form of medical treatment used as a substitute for conventional medicine. For example, alternative therapy can be used in the form of special diet or herbal concoction to treat cancer instead of conventional therapeutic modalities (eg. surgery, radiation therapy, or chemotherapy). This form of medicine may be based on elaborate systems of theory and clinical practice.

What are herbs? Herbs include flowering plants, shrubs, trees, moss, fern, algae, seaweed or fungus. In most cultures, including Western culture, herbs are used not only as a part of the treatment of disease, but also in the enhancement of life, physically, emotionally and spiritually. Plant parts, including flowers, fruits, leaves, twigs, bark, roots or seeds, are all considered usable.

What are dietary supplements? By definition, a dietary supplement is a product taken by mouth and intended to supplement the diet. These products may include vitamins, minerals, herbs or other botanicals, amino acids and substances such as enzymes, organ tissues, glandulars and metabolites.

Are they medicines? The term "drug" comes from the ancient word for "root." Until the 1930s, medical schools taught that plant drugs were the primary medicines available. In general, since that time, patented pharmaceuticals (prescription or over-the-counter medications) have replaced the herbs or "roots," which were either found too weak or unsafe. Like drugs or foods, medicinal plants (herbs) and dietary products (vitamins, minerals, amino acids) have many actions in the body.

In what types of preparations are herbal medicines available? Herbs are available in many forms, depend­ing on the type of plant and its use. Some plants are best used fresh, but they are highly perishable. Dried, chopped or whole herbs can be steeped as teas (infusions) or simmered over low heat (decoctions). Some fresh and/or dried herbs are preserved in alcohol (tinctures), while others are better suited to vinegar extracts (acetracts), syrups, glycerites (in vegetable glycerine) or miels (in honey). Freeze-dried or herbal powders also come in bulk, tablet, capsule, paste or concentrate (4-6 times regular strength). Other ways to administer herbs may be by suppositories, creams, gels, liniments, oils, compresses, steams, aromatics (oils) or baths.

Do I need to tell my doctor about all of the herbal products and other supplements that I take? Yes. It is absolutely essential that you tell your doctor about any treatments that you are using. These include the use of herbal medicines, vitamins, nutritional supplements or any other prescribed or over-the-counter drugs. Many of the popular herbal products on the market can cause harmful side effects or interact with your other medicines.

Could herbal medicines and other dietary supplements affect my anaesthesia if I need surgery?

Anaesthesiologists are conducting research to determine exactly how certain herbs and dietary supplements interact with certain anaesthetics. They are finding that certain herbal medicines may prolong the effects of anaesthesia. Others may increase the risks of bleeding or raise blood pressure. Some effects may be subtle and less critical, but for anaesthesiologists, anticipating a possible reaction is better than reacting to an unexpected condition. So it is very important to tell your doctor about everything you are taking before surgery.

Many people supplement their diets or vitamin regimens with herbal products such as Ginseng, St. John's wort or Goldenseal. Some of these herbal products have side effects that can affect your anaesthesia or surgery. Therefore, it is very important that you notify your anaesthesiologist not only of your prescription medications, but also of any herbal medications you are taking.

There has been recent concern in the media over the possible detrimental effects of herbal medicines on the perioperative period. Perceived by the public as 'natural'and therefore safe, herbal remedies may have led to adverse events such as myocardial infarction, bleeding, prolonged or inadequate anaesthesia and rejection of transplanted or­gans.In addition, herbal remedies can interact with many drugs given in the perioperative period.

Self-administration of herbal medicines is commonin patients presenting for anaesthesia. Because of the potential for side-effects and drug interactions it is important for anaesthetiststo be aware of their use.

There has been increasing concern in the American medical press about the potential complications arising in the perioperative period as a result of patients' use of complementary medicines. The assumption by patients and doctors that these products 'are natural and therefore safe' is clearly dangerous. Morbidityand mortality are more likely in the perioperative period because of the polypharmacy and assaults on normal physiology that occur. Such complications may include myocardial infarction, bleeding, prolonged or inadequate anaesthesia and organ transplant rejection.

What are herbal products and what are the concerns?

Herbal products are also known as dietary supplements, alternative therapies, complementary medicine, and homeo­pathic healthcare. Some of the most common herbal products are: ephedra, feverfew, garlic, ginger, ginkgo, ginseng, kava, and St. John's Wort. Herbal products are available as tablets, liquids, granules, or powders. They may be available in their natural state as well. The Dietary Supplement Health& Education Act of 1994 considers herbal products to be foods or dietary supplements. Therefore, they are not regulated by the Food and DrugAdministration. There are few instructions on proper use and dosage requirements, and little information about possible side effects, toxicity and possible drug interac­tions. While many herbal products offer noticeable health benefits when used correctly, taking herbal products right up until the day of your procedure/surgery may have an impact on the success of your anaesthetic and procedure. Concerns may arise when herbal products interact with anaesthetics. Some of the potential side effects are increased surgical bleeding, heart and blood pressure effects, reaction with sedatives and changes in the body's reactions to certain medications.

What you should do before having an anaesthetic

  • STOP taking the herbal product at least two weeks prior to the scheduled procedure or surgery to prevent side effects.
  • Inform your surgeon and anaesthesia provider that you are taking an herbal product.
  • Offer accurate information about any herbal products you are taking.
  • When asked about your medication history, include all herbal products, over-the-counter drugs, dietary supplements, minerals, and teas.
  • If you are not sure of the contents of an herbal product, then bring the product and the container it comes in with you for the preoperative anaesthesia interview.
  • Make sure that someone close to you is aware that you take an herbal product. In the event that you need
  • emergency care, this person will need to share this information with your healthcare providers.
  • Realize that herbal products need to be treated as medicine. Even if the product is natural, it still may be harmful when combined with anaesthetics.
The anaesthesiologists should have a detailed knowledge and understanding of the potential risks and purported benefits of herbal medicines and should thoroughly inquire about patient's use of herbal products. In addition, the education of each patient regarding the serious, potential drug-herb interactions should be a routine component of preoperative assessment. The American Society of Anaesthesiologists (ASA), suggests that all herbal medications should be discontinued 2 to 3 weeks before an elective surgical procedure. If the patient is not sure of the contents of the herbal medicine. He or she should be urged to bring the container so that the anaesthesiologist can review the contents of the herb or preparation. Although this idea holds some promise in the elective-care settings, anaesthetic care in emergency settings should be based on a thorough drug-intake history from the patient or a relative, if possible.

Unfortunately, the anaesthesia literature has not addressed this new group of health supplements, despite many of these drugs having the potential to cause serious health problems and drug-herb interactions. There is a need to conduct additional scientific clinical trials to study the anaesthetic responses to commonly used nutraceutical agents.




 

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