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Elvir Lazo OL, White PF, Lee C, Cruz Eng H, Matin JM, Lin C, Del Cid F, Yumul R. Use of herbal medication in the perioperative period: Potential adverse drug interactions. J Clin Anesth 2024; 95:111473. [PMID: 38613937 DOI: 10.1016/j.jclinane.2024.111473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 02/26/2024] [Accepted: 04/08/2024] [Indexed: 04/15/2024]
Abstract
Use of herbal medications and supplements has experienced immense growth over the last two decades, with retail sales in the USA exceeding $13 billion in 2021. Since the Dietary Supplement Health and Education Act (DSHEA) of 1994 reduced FDA oversight, these products have become less regulated. Data from 2012 shows 18% of U.S. adults used non-vitamin, non-mineral natural products. Prevalence varies regionally, with higher use in Western states. Among preoperative patients, the most commonly used herbal medications included garlic, ginseng, ginkgo, St. John's wort, and echinacea. However, 50-70% of surgical patients fail to disclose their use of herbal medications to their physicians, and most fail to discontinue them preoperatively. Since herbal medications can interact with anesthetic medications administered during surgery, the American Society of Anesthesiologists (ASA) and the American Association of Nurse Anesthetists (AANA) recommend stopping herbal medications 1-2 weeks before elective surgical procedures. Potential adverse drug effects related to preoperative use of herbal medications involve the coagulation system (e.g., increasing the risk of perioperative bleeding), the cardiovascular system (e.g., arrhythmias, hypotension, hypertension), the central nervous system (e.g., sedation, confusion, seizures), pulmonary (e.g., coughing, bronchospasm), renal (e.g., diuresis) and endocrine-metabolic (e.g., hepatic dysfunction, altered metabolism of anesthetic drugs). During the preoperative evaluation, anesthesiologists should inquire about the use of herbal medications to anticipate potential adverse drug interactions during the perioperative period.
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Affiliation(s)
| | - Paul F White
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; White Mountain Institute, The Sea Ranch, CA 95497, USA.
| | - Carol Lee
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Hillenn Cruz Eng
- Department of Anesthesiology, Adena Health System, Chillicothe, OH, USA.
| | - Jenna M Matin
- Tulane University School of Medicine, New Orleans, LA, USA.
| | - Cory Lin
- Department of Anesthesiology and Perioperative Care, University of California Irvine, CA, USA.
| | - Franklin Del Cid
- Department of Anesthesiology, Hospital Escuela, Tegucigalpa, Honduras.
| | - Roya Yumul
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; David Geffen School of Medicine-UCLA, Charles R, Drew University of Medicine and Science, Los Angeles, CA, USA.
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Boet S, Burns JK, Cheng-Boivin O, Khan H, Derry K, Diep D, Djokhdem AH, Um SW, Huang JW, Paré D, Deng M, Begunova L, Fei LYN, Bezzahou M, Andrahennadi PS, Grose E, Abebe RG, Mansour F, Talbot Z, Dion PM, Kaur M, Choueiry J, Etherington C. Mapping multicenter randomized controlled trials in anesthesiology: a scoping review. Syst Rev 2021; 10:276. [PMID: 34702366 PMCID: PMC8549299 DOI: 10.1186/s13643-021-01776-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 07/26/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Evidence suggests that there are substantial inconsistencies in the practice of anesthesia. There has not yet been a comprehensive summary of the anesthesia literature that can guide future knowledge translation interventions to move evidence into practice. As the first step toward identifying the most promising interventions for systematic implementation in anesthesia practice, this scoping review of multicentre RCTs aimed to explore and map the existing literature investigating perioperative anesthesia-related interventions and clinical patient outcomes. METHODS Multicenter randomized controlled trials were eligible for inclusion if they involved a tested anesthesia-related intervention administered to adult surgical patients (≥ 16 years old), with a control group receiving either another anesthesia intervention or no intervention at all. The electronic databases Embase (via OVID), MEDLINE, and MEDLINE in Process (via OVID), and Cochrane Central Register of Control Trials (CENTRAL) were searched from inception to February 26, 2021. Studies were screened and data were extracted by pairs of independent reviewers in duplicate with disagreements resolved through consensus or a third reviewer. Data were summarized narratively. RESULTS We included 638 multicentre randomized controlled trials (n patients = 615,907) that met the eligibility criteria. The most commonly identified anesthesia-related intervention theme across all studies was pharmacotherapy (n studies = 361 [56.6%]; n patients = 244,610 [39.7%]), followed by anesthetic technique (n studies = 80 [12.5%], n patients = 48,455 [7.9%]). Interventions were most often implemented intraoperatively (n studies = 233 [36.5%]; n patients = 175,974 [28.6%]). Studies typically involved multiple types of surgeries (n studies = 187 [29.2%]; n patients = 206 667 [33.5%]), followed by general surgery only (n studies = 115 [18.1%]; n patients = 201,028 [32.6%]) and orthopedic surgery only (n studies = 94 [14.7%]; n patients = 34,575 [5.6%]). Functional status was the most commonly investigated outcome (n studies = 272), followed by patient experience (n studies = 168), and mortality (n studies = 153). CONCLUSIONS This scoping review provides a map of multicenter RCTs in anesthesia which can be used to optimize future research endeavors in the field. Specifically, we have identified key knowledge gaps in anesthesia that require further systematic assessment, as well as areas where additional research would likely not add value. These findings provide the foundation for streamlining knowledge translation in anesthesia in order to reduce practice variation and enhance patient outcomes.
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Affiliation(s)
- Sylvain Boet
- Department of Anesthesiology and Pain Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8L1, Canada. .,Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada. .,Department of Innovation in Medical Education, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8L1, Canada.
| | - Joseph K Burns
- Department of Anesthesiology and Pain Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8L1, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Olivia Cheng-Boivin
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Hira Khan
- Department of Health Sciences, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada
| | - Kendra Derry
- Department of Anesthesiology and Pain Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Deric Diep
- Department of Anesthesiology and Pain Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Abdul Hadi Djokhdem
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Sung Wook Um
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - Johnny W Huang
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Danica Paré
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Mimi Deng
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Liza Begunova
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, 03755, USA
| | - Linda Yi Ning Fei
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Maryam Bezzahou
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | | | - Elysia Grose
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Ruth G Abebe
- Faculty of Health Sciences, University of Ottawa, 125 University, Ottawa, ON, K1N 6N5, Canada
| | - Fadi Mansour
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Zoé Talbot
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | | | - Manvinder Kaur
- Department of Anesthesiology and Pain Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Justen Choueiry
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Cole Etherington
- Department of Anesthesiology and Pain Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8L1, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
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Kelleher DC, Kirksey MA, Wu CL, Cheng SI. Integrating complementary medicine in the perioperative period: a simple, opioid-sparing addition to your multimodal analgesia strategy? Reg Anesth Pain Med 2020; 45:468-473. [PMID: 32193284 DOI: 10.1136/rapm-2019-100947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 02/23/2020] [Accepted: 02/27/2020] [Indexed: 01/29/2023]
Abstract
The current US opioid health-related crisis underscores the importance for perioperative physicians to optimize various approaches to pain management. Multimodal techniques and enhanced recovery after surgery (ERAS) protocols are frequently cited as the most effective strategies for improving the experience of pain and reducing opioid exposure. Complementary medicine (CM) techniques, while frequently shown to be effective at reducing opioid and other pharmacologic agent use, are rarely discussed as part of these multimodal strategies. In general, CM therapies are low-cost with minimal associated risk, making them an ideal choice for incorporation into ERAS and other opioid-sparing protocols. In this Daring Discourse, we discuss the benefits and challenges of incorporating CM therapy into anesthetic practice. We hope that anesthesiologists can become more familiar with the current evidence regarding perioperative CM therapy, and begin incorporating these therapies as part of their comprehensive multimodal approach to perioperative pain management.
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Affiliation(s)
- Deirdre C Kelleher
- Department of Anesthesiology, Weill Cornell Medical College, New York, New York, USA
| | - Meghan A Kirksey
- Department of Anesthesiology, Weill Cornell Medical College, New York, New York, USA.,Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Christopher L Wu
- Department of Anesthesiology, Weill Cornell Medical College, New York, New York, USA.,Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Stephanie I Cheng
- Department of Anesthesiology, Weill Cornell Medical College, New York, New York, USA.,Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
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Trifa M, Tumin D, Walia H, Lemanek KL, Tobias JD, Bhalla T. Caregivers' knowledge and acceptance of complementary and alternative medicine in a tertiary care pediatric hospital. J Pain Res 2018. [PMID: 29535550 PMCID: PMC5837374 DOI: 10.2147/jpr.s156585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The use of complementary and alternative medicine (CAM) therapies has increased in children, especially in those with chronic health conditions. However, this increase may not translate into acceptance of CAM in the perioperative setting. We surveyed caregivers of patients undergoing surgery to determine their knowledge and acceptance of hypnotherapy, acupuncture, and music therapy as alternatives to standard medication in the perioperative period. Materials and methods An anonymous, 12-question survey was administered to caregivers of children undergoing procedures under general anesthesia. Caregivers reported their knowledge about hypnotherapy, music therapy, and acupuncture and interest in one of these methods during the perioperative period. CAM acceptance was defined as interest in one or more CAM methods. Results Data from 164 caregivers were analyzed. The majority of caregivers were 20-40 years of age (68%) and mothers of the patient (82%). Caregivers were most familiar with acupuncture (70%), followed by music therapy (60%) and hypnotherapy (38%). Overall CAM acceptance was 51%. The acceptance of specific CAM modalities was highest for music therapy (50%), followed by hypnotherapy (17%) and acupuncture (13%). In multivariable logistic regression, familiarity with music therapy was associated with greater odds of CAM acceptance (odds ratio=3.36; 95% CI: 1.46, 7.74; P=0.004). Conclusion Overall CAM acceptance among caregivers of children undergoing surgery was 51%, with music therapy being the most accepted CAM method. Familiarity with music therapy was the only factor that was independently associated with accepting CAM in the perioperative period. The low acceptance for acupuncture and hypnosis in the perioperative situation may be related to insufficient parental knowledge and information.
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Affiliation(s)
- Mehdi Trifa
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Dmitry Tumin
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Hina Walia
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kathleen L Lemanek
- Department of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Joseph D Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Tarun Bhalla
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
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Oates A, Benedict KA, Sun K, Brakeman PR, Lim J, Kim C. Laser acupuncture reduces pain in pediatric kidney biopsies: a randomized controlled trial. Pain 2017; 158:103-109. [PMID: 27749608 PMCID: PMC5234680 DOI: 10.1097/j.pain.0000000000000734] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Evaluate laser acupuncture (LA) as an adjuvant therapy in pain management during percutaneous kidney biopsy procedure in children and adolescents. This prospective, double-blinded, randomized controlled trial enrolled patients aged 7 to 26 years admitted to a children's hospital for percutaneous kidney biopsy. Patients received LA to treatment points (acupuncture group) or sham points (control group) before the procedure. The laser delivered a dose of 42 J/cm over 10 acupoints. Patients and parents rated the pain during and after the biopsy, and change in pain scores were calculated for each patient. Anxiety, vital signs, sedation medication, and patient's biopsy experience were secondary outcomes. Sixty-nine treatments (33 in the acupuncture group and 36 in the control group) were eligible for analysis. Patients in the acupuncture group reported a significantly improved change in the pain score after the biopsy compared with the controls (0.8 vs -0.5, P = 0.044). Patients in the acupuncture group had a statistically significant decrease in procedure vital signs including heart rate (-1.8 vs 5.6, P = 0.043) and respiratory rate (-2.4 vs 0.4, P = 0.045) when compared with controls. Parents also perceived a correspondingly greater improvement in their child's pain for those in the acupuncture group compared with the controls (2.3 vs 0.3, P = 0.04). Adjunctive LA significantly improved pain after pediatric percutaneous kidney biopsies.
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Affiliation(s)
- Aris Oates
- UCSF Benioff Children’s Hospital, University of California, San Francisco, San Francisco, CA
| | - Kelly A Benedict
- UCSF Benioff Children’s Hospital, University of California, San Francisco, San Francisco, CA
| | - Karen Sun
- UCSF Benioff Children’s Hospital, University of California, San Francisco, San Francisco, CA
| | - Paul R Brakeman
- UCSF Benioff Children’s Hospital, University of California, San Francisco, San Francisco, CA
| | - Jessica Lim
- UCSF Benioff Children’s Hospital, University of California, San Francisco, San Francisco, CA
| | - Cynthia Kim
- UCSF Benioff Children’s Hospital, University of California, San Francisco, San Francisco, CA
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