Herbal Supplements

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Herbal supplements can significantly affect anesthesia and perioperative outcomes, primarily through effects on coagulation, cardiovascular stability, drug metabolism, and central nervous system depression. The most commonly implicated supplements include Ginkgo biloba, garlic, ginseng, St. John’s wort, kava, valerian, and turmeric, among others.[1][2][3][4]

Ginkgo biloba is notable for its antiplatelet effects, which can increase the risk of perioperative bleeding. Case reports have linked ginkgo to spontaneous intracranial hemorrhage and postoperative bleeding. The mechanism involves inhibition of platelet-activating factor, and the Society for Perioperative Assessment and Quality Improvement (SPAQI) recommends discontinuing ginkgo at least 2 weeks before surgery.[3][1][5]

Turmeric (curcumin) also inhibits platelet aggregation and can increase bleeding risk via effects on thromboxane metabolism and calcium channel inhibition. SPAQI recommends holding turmeric for 2 weeks preoperatively.[3] While preclinical data suggest curcumin may have analgesic and anti-inflammatory effects that could benefit postoperative pain, its impact on bleeding risk is the primary perioperative concern.[6][7]

Fava beans are not a typical herbal supplement but are relevant for patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency, as they can precipitate hemolytic anemia. There is no direct evidence of fava beans interacting with anesthetic drugs, but their antinutritional factors and potential for hemolysis should be considered in susceptible patients.[8][9]

Other supplements such as garlic, ginseng, and St. John’s wort also pose risks: garlic and ginseng increase bleeding risk, while St. John’s wort induces hepatic enzymes, potentially altering the metabolism of anesthetic agents and increasing the risk of serotonin syndrome when combined with serotonergic drugs.[1][3]

The American Society of Anesthesiologists and SPAQI recommend discontinuing most herbal supplements 1–2 weeks before surgery to minimize adverse interactions and bleeding risk.[2][3][4] A thorough preoperative history of supplement use is essential, as many patients do not disclose this information unless specifically asked.

References

1. Herbal Medicines and Perioperative Care. Ang-Lee MK, Moss J, Yuan CS. JAMA. 2001;286(2):208-16. doi:10.1001/jama.286.2.208.

2. Use of Herbal Medication in the Perioperative Period: Potential Adverse Drug Interactions. Elvir Lazo OL, White PF, Lee C, et al. Journal of Clinical Anesthesia. 2024;95:111473. doi:10.1016/j.jclinane.2024.111473.

3. Preoperative Management of Surgical Patients Using Dietary Supplements: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement. Cummings KC, Keshock M, Ganesh R, et al. Mayo Clinic Proceedings. 2021;96(5):1342-1355. doi:10.1016/j.mayocp.2020.08.016.

4. The Peri-Operative Implications of Herbal Medicines. Hodges PJ, Kam PC. Anaesthesia. 2002;57(9):889-99. doi:10.1046/j.1365-2044.2002.02781.x.

5. Ginkgo Biloba: Indications, Mechanisms, and Safety. Diamond BJ, Bailey MR. The Psychiatric Clinics of North America. 2013;36(1):73-83. doi:10.1016/j.psc.2012.12.006.

6. Antinociceptive Effects of Curcumin in a Rat Model of Postoperative Pain. Zhu Q, Sun Y, Yun X, et al. Scientific Reports. 2014;4:4932. doi:10.1038/srep04932.

7. Curcumin Treatment Attenuates Pain and Enhances Functional Recovery After Incision. Sahbaie P, Sun Y, Liang DY, Shi XY, Clark JD. Anesthesia and Analgesia. 2014;118(6):1336-44. doi:10.1213/ANE.0000000000000189.

8. Nutritional and Antinutritional Composition of Fava Bean (Vicia Faba L., Var. Minor) Cultivars. Mayer Labba IC, Frøkiær H, Sandberg AS. Food Research International (Ottawa, Ont.). 2021;140:110038. doi:10.1016/j.foodres.2020.110038.

9. Fava Bean (Vicia Faba L.) for Food Applications: From Seed to Ingredient Processing and Its Effect on Functional Properties, Antinutritional Factors, Flavor, and Color. Sharan S, Zanghelini G, Zotzel J, et al. Comprehensive Reviews in Food Science and Food Safety. 2021;20(1):401-428. doi:10.1111/1541-4337.12687.