Going For Surgery? Remember This..

This sounds very scary, how could something so critical yet doctors don't take the trouble to ask their patients before they prepare them for surgery?? My doctor colleagues were quite puzzled recently when a patient, after undergoing routine surgery, took a longer time than usual to wake up after GA was completed and stopped. The patient required an overnight stay in the ICU before finally waking up 24 hours later! It was subsequently discovered that the patient had been taking supplements, in this case, St John’s Wort. This popular supplement,EPO, needs to be stopped 2 weeks prior to surgery (see text) Before undergoing surgery, one important info which must be disclosed to your doctor is whether you are taking herbal supplements. This is often left out by patients when doctors enquire on what medications they are taking, as often many people do not equate medicines with supplements. Many intensive care physicians including anaesthesiologists will tell you of their experience with patients who take a long time to wake up after surgery; develop fits upon recovery or bleed excessively after surgery; all due to the taking of herbals. Incidents like the above used to mystify many doctors previously but evidence is now clear that several over-the- counter supplements can interfere with the various actions of medications used during surgery. Take a look below at some common examples: Herbal supplement Possible complications Aloe vera May cause increased intestinal muscle movement to digest food (peristalsis), may decrease effectiveness of water pills (diuretics) given after surgery Bromelain May cause bleeding or interact with antibiotics such as amoxicillin or tetracyclines Danshen May cause bleeding Dong quai May cause bleeding Echinacea May interfere with immune functioning, may alter effectiveness of immunosuppressant drugs given after transplant surgery Ephedra May cause abnormal heartbeat, may cause extreme high blood pressure and coma if combined with certain antidepressants and anesthesia Feverfew May cause bleeding Garlic May cause bleeding, may interfere with normal blood clotting Ginger May cause bleeding Ginkgo May cause bleeding Ginseng May cause bleeding, may cause rapid heartbeat, may cause high blood pressure Goldenseal May cause or worsen swelling and high blood pressure Kava May enhance sedative effects of anesthesia Licorice (not including licorice candy) May increase blood pressure Omega-3 fatty acids May cause bleeding if taken in doses greater than 3 grams a day Senna May cause electrolyte imbalance St. John’s wort May increase or decrease the effects of some drugs used during and after surgery Valerian May prolong the effects of anesthesia The above list is not exhaustive. As more cases are encountered, the list gets longer! Evening Primrose Oil (EPO) is now implicated in the cause of fits or seizures following general anaesthesia. Some points to note if you are undergoing planned surgery: 1. Remember that the list of medications that you need to reveal to your doctor includes all supplements, whether as pills or as a drink. 2. Some of these herbals may have to be stopped more than 2 weeks prior to planned surgery. 3. In emergency surgery, remember to reveal to your doctor and next-of-kin what you are taking so that some preventive measures may be undertaken beforehand by the doctors. 4. Some people believe if something is natural, it is safe. That is not necessarily true. If in doubt, show your care-giver the original container of the supplement.