Anesthesia and Herbal Supplements

The use of herbal supplements is on the rise. From 22 to 34% of preoperative adults admit to taking them. As many as one in five patients use herbal supplements while taking prescription medication. Blanck et al. found that 61% of patients with a chronic disease did not discuss their use of dietary herbal supplements with their physicians. Furthermore, 70% of preoperative adults did not disclose their use of herbal supplements even when specifically asked during their preanesthetic assessment (Supplemental Digital Content 1, http://links.lww.com/ASA/A189). Of 601 children presenting for ambulatory surgery, 10.1% had taken herbal supplements in the past and 6.4% were taking herbs currently. Of these, 85% of the parents had not told their child’s physician about the supplements and 90% had not told their surgical team (Supplemental Digital Content 2, http://links.lww.com/ASA/A190). Among children in this survey who were taking herbal supplements, 16% were using herbs that could impact perioperative care. In a survey of parturients, 15% were using herbal supplements and 41% of these patients did not think of the supplements as drugs. Because patients often do not view herbal supplements as drugs, it is very important to ask about them specifically when obtaining a history (Supplemental Digital Content 3, http://links.lww.com/ASA/A191). The Dietary Supplement Health and Education Act became law in the United States in 1994. It is an amendment to the Federal Food, Drug and Cosmetic Act and states that the manufacturer, not the Food and Drug Administration (FDA), is responsible for the safety of the supplement. Dietary supplements are legally considered ‘‘foods,’’ not drugs (Supplemental Digital Content 4, http://links.lww.com/ASA/A192). They include vitamins, minerals, herbs or other botanicals, amino acids, concentrates, metabolites, constituents, extracts, or ‘‘a dietary substance for use by man to supplement the diet by increasing the total dietary intake (e.g., enzymes or tissues from organs or glands).’’ All supplements carry the following disclaimer: ‘‘This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease.’’ Regardless of the pharmacological action of the supplement, according to the Dietary Supplement Health and Education Act, only a drug can legally make that claim. All supplements marketed before the Dietary Supplement Health and Education Act are included and do not need approval from the