Perioperative Considerations of Herbal Medications

Background: A considerable portion of the US population uses herbal supplements on a daily basis for their various proposed beneficial effects. However, the over-the-counter nature of these medications and lack of knowledge of adverse effect profiles can have unexpected serious impact on the perioperative course. The growing list of supplements presents a pharmacologic conundrum to the anesthesiologist. Objective: The study aimed to compile a comprehensive list of vitamins, herbals, and supplements used commonly by patients, describe the risks associated with them, and identify recommendations for perioperative management. Method: The current literature on PubMed and Medline was reviewed for the years 2000 through 2016. The reference lists of each selected article were also reviewed for additional sources of information. Results: The review identified 23 herbals and supplements that are commonly used and their perioperative considerations. Conclusion: The management of herbals and supplements is an issue for the anesthesiologist. Although it would be prudent to stop the use of most substances a week or more preoperatively, the perioperative physician must be wary of the potential for withdrawal.