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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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Büyükkasap AE, Yazıcı G. Knowledge levels of doctors and nurses working in surgical clinics about nutrients and food supplements, a multicentre descriptive study. BMC Nurs 2024; 23:277. [PMID: 38664695 PMCID: PMC11044485 DOI: 10.1186/s12912-024-01968-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/22/2024] [Indexed: 04/29/2024] Open
Abstract
PURPOSE The use of nutrients and food supplements is increasing worldwide. Nutrients and food supplements frequently used in the surgical period may cause complications and side effects. This study was conducted to determine the level of knowledge about sixty-one nutrients and food supplements among doctors and nurses working in surgical clinics. DESIGN A multicentre descriptive, quantitative, cross-sectional study. METHODS The study was conducted between 15 February and 31 May 2022 with a total of 410 participants, including 143 doctors and 267 nurses, working in the surgical clinics of 8 hospitals, including public, university and private hospitals, within the borders of one province in Turkey. Data were collected face-to-face using a questionnaire developed by the researchers, which included descriptive characteristics of the doctors and nurses and questions about sixty-one nutrients and food supplements. RESULTS The median overall success score of the doctors and nurses participating in the study regarding the use of nutrients and food supplements was 3.20 out of 100 points, the median success score of complications and side effects of nutrients and food supplements in the surgical period was 7.06 out of 33 points, the median success score for discontinuation of nutrients and food supplements prior to surgery was 0.21 out of 16 points, and the median success score for drug interactions of nutrients and food supplements was 1.70 out of 51 points. In addition, it was found that the overall success scores of doctors and nurses regarding nutrients and food supplements increased statistically significantly with increasing age and working years. The total success score of doctors and nurses who received training in nutrients and food supplements was statistically significantly higher than that of doctors and nurses who did not receive training. CONCLUSION In conclusion, it was found that the level of knowledge of nutrients and food supplements among doctors and nurses working in surgical clinics was less than half or even close to zero. Therefore, it is recommended that training on nutrients and food supplements should be included in the undergraduate and postgraduate education of doctors and nurses in order to prevent complications, side effects, drug interactions and patient safety related to the use of nutrients and food supplements in the surgical period.
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Affiliation(s)
| | - Gülay Yazıcı
- Faculty of Health Sciences, Ankara Yıldırım Beyazıt University, Ankara, Turkey
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3
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Khan MF, Muzaffar A, Shamim F. History conflict and non-formulary medicine: a threat for anaesthesiologist in low and middle-income countries. BMJ Case Rep 2018; 2018:bcr-2017-224141. [PMID: 30158256 PMCID: PMC6119358 DOI: 10.1136/bcr-2017-224141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2018] [Indexed: 11/03/2022] Open
Abstract
The practice of complementary and non-formulary medicine has gained tremendous popularity due to their claimed beneficial effects in cardiac, respiratory and chronic diseases, as also other disorders. The most threatening aspect related to these practices pertains to the non-disclosure of its use by patients at the time of their preoperative assessment in elective or emergency setting. We report a case of profound, long-lasting unexplained hypotension during and after anaesthesia in a patient presented for emergency vocal cord surgery (cordectomy). He was taking complementary medicine for last 2 years. Serum cortisol level was sent postoperatively in intensive care unit that was found extremely low.
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Affiliation(s)
| | - Areeba Muzaffar
- Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
| | - Faisal Shamim
- Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
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Saraghi M, Golden LR, Hersh EV. Anesthetic Considerations for Patients on Antidepressant Therapy-Part I. Anesth Prog 2018; 64:253-261. [PMID: 29200376 DOI: 10.2344/anpr-64-04-14] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Millions of patients take antidepressant medications in the United States for the treatment of depression or anxiety disorders. Some antidepressants are prescribed off-label to treat problems such as chronic pain, low energy, and menstrual symptoms. Antidepressants are a broad and expansive group of medications, but the more common drug classes include tricyclic antidepressants, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and monoamine oxidase inhibitors. A miscellaneous or "atypical" category covers other agents. Some herbal supplements that claim to have antidepressant activity will also be discussed. In Part I of this review, antidepressant pharmacology, adverse effects, and drug interactions with adrenergic agonists will be discussed. In part II, drug interactions with sedation and general anesthetics will be reviewed. Bleeding effects and serotonin syndrome implications in anesthetic practice will also be highlighted.
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Affiliation(s)
- Mana Saraghi
- Director, Dental Anesthesiology Residency Program, Jacobi Medical Center, Bronx, New York
| | - Leonard R Golden
- Chairman, Department of Anesthesiology, Jacobi Medical Center Bronx, New York
| | - Elliot V Hersh
- Professor, Pharmacology Director, Division of Pharmacology and Therapeutics, Department of Oral and Maxillofacial Surgery, University of Pennsylvania, Philadelphia
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Herbal Use among Presurgical Patients in Turkey: A Cross-Sectional Study. Anesthesiol Res Pract 2018; 2018:1643607. [PMID: 29849607 PMCID: PMC5914109 DOI: 10.1155/2018/1643607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 02/05/2018] [Accepted: 02/27/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction For centuries before the advent of modern medicine, traditional medicinal plants were the major agents for primary health care. Their use declined in most developed western countries during the last century's industrialization and urbanization. But, the last two decades have witnessed a new resurgence of interest in herbal and alternative medicines. Methods The survey was conducted at the Anaesthesiology and Reanimation Department of Training and Research Hospital of Health and Science University among patients who had undergone elective surgery between January 1st 2016 and April 1st 2016. A questionnaire composed of 15 questions was used. Results A total 87 (14.5%) patients reported the use of herbal medications. Twenty five patients were taking a single herbal medication and 52 patients were taking more than one. 92.5% of patients do not know the side effects of herbal medications. 35 cases of operation patients were questioned by the physician about herbal use, and 228 cases were not questioned by the physician. Conclusion Anesthesiologist should be aware of the effects of herbals on body functions and possible herbal-drug interactions to take care of such potentional perioperative complications.
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Alegbeleye BJ. Sudden cardiac arrest under spinal anesthesia in a mission hospital: a case report and review of the literature. J Med Case Rep 2018; 12:144. [PMID: 29792218 PMCID: PMC5966884 DOI: 10.1186/s13256-018-1648-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/07/2018] [Indexed: 11/23/2022] Open
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Kumari A, Gupta R, Bajwa SJS, Singh A. Unanticipated cardiac arrest under spinal anesthesia: An unavoidable mystery with review of current literature. Anesth Essays Res 2015; 8:99-102. [PMID: 25886115 PMCID: PMC4173580 DOI: 10.4103/0259-1162.128923] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Cardiac arrest during anesthesia and perioperative period is a matter of grave concern for any anesthesiologist. But such mishaps have been reported for one reason or the other in the literary sciences. We are reporting the occurrence of unanticipated delayed cardiac arrest following spinal anesthesia in two young and healthy patients. Fortunately, these patients were successfully resuscitated with timely and appropriate cardiopulmonary resuscitative measures. Occurrence of such cases needs timely reporting and exploring all the possible causes of these unusual and possibly avoidable events. The present case reports are an important addition to a series of recently published mishaps that occurred during spinal anesthesia in young and healthy patients.
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Affiliation(s)
- Anita Kumari
- Department of Anaesthesiology and Intensive Care, Sri Guru Ram Das Institute of Medical sciences, Vallah, Amritsar, India
| | - Ruchi Gupta
- Department of Anaesthesiology and Intensive Care, Sri Guru Ram Das Institute of Medical sciences, Vallah, Amritsar, India
| | - Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India
| | - Amrinder Singh
- Department of Anaesthesiology and Intensive Care, Sri Guru Ram Das Institute of Medical sciences, Vallah, Amritsar, India
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Bajwa SJS, Kalra S, Takrouri MSM. Quaternary prevention in anesthesiology: Enhancing the socio-clinical standards. Anesth Essays Res 2015; 8:125-6. [PMID: 25886213 PMCID: PMC4173603 DOI: 10.4103/0259-1162.134470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Banur, Punjab, India
| | | | - Mohamad Said Maani Takrouri
- Department of Anesthesiia, Alsafwah Center, Office No(1209) Prince Mandouh Bin Abdelaziz Street, Riyadh, P.O.Box 22422 pin code 11495, KSA. E-mail:
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Bajwa SJS. Clinical conundrums and challenges during geriatric orthopedic emergency surgeries. Int J Crit Illn Inj Sci 2015; 5:38-45. [PMID: 25810963 PMCID: PMC4366827 DOI: 10.4103/2229-5151.152342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Despite so many advancements and innovations in anesthetic techniques, expectations and challenges have also grown in plenty. Cardiac, pediatric, obstetric and neuro-anesthesia have perfectly developed to fulfill the desired needs of respective patient population. However, geriatric anesthesia has been shown a lesser interest in teaching and clinical practices over the years as compared with other anesthetic sub-specialties. The large growing geriatric population globally is also associated with an increase number of elderly patients presenting for orthopedic emergency surgeries. Orthopedic emergency surgery in geriatric population is not only a daunting clinical challenge but also has numerous socio-behavioral and economic ramifications. Decision making in anesthesia is largely influenced by the presence of co-morbidities, neuro-cognitive functions and the current socio-behavioral status. Pre-anesthetic evaluation and optimization are extremely important for a better surgical outcome but is limited by time constraints during emergency surgery. The current review aims to highlight comprehensively the various clinical, social, behavioral and psychological aspects during pre-anesthetic evaluation associated with emergency orthopedic surgery in geriatric population.
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Affiliation(s)
- Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Banur, Punjab, India
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Bajwa SJS, Sehgal V, Kalra S, Baruah MP. Management of diabetes mellitus type-2 in the geriatric population: Current perspectives. J Pharm Bioallied Sci 2014; 6:151-7. [PMID: 25035634 PMCID: PMC4097928 DOI: 10.4103/0975-7406.130956] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 06/06/2013] [Accepted: 09/29/2013] [Indexed: 01/04/2023] Open
Abstract
The prevalence of diabetes mellitus (DM) has increased exponentially throughout the world and there is rapid increase in elderly diabetics. DM is associated with increased mortality and considerable morbidity including stroke, heart disease, and diminished quality of life in the elderly. However, the unique features of geriatric diabetes have not been given due a prominence in medical literature. Hypoglycemia remains the biggest complicating factor and needs to be avoided in the elderly. Most people in the geriatric age group have some degree of renal insufficiency and medications need to be adjusted wisely with changing renal profile. Because safer and more effective pharmacological therapy is available, an individual approach to DM in the elderly is essential.
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Affiliation(s)
- Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care Medicine, Gian Sagar Medical College and Hospital, Patiala, Punjab, India
| | - Vishal Sehgal
- Department of Internal Medicine, The Common Wealth Medical College, Scranton, PA 18510, USA
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and B.R.I.D.E., Karnal, Haryana, India
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Bhaskar SB, Bajwa SJS. From pre-operative comorbidities to post-operative cognitive dysfunction: The challenging face of geriatric anaesthesia. Indian J Anaesth 2014; 58:248-50. [PMID: 25024464 PMCID: PMC4090987 DOI: 10.4103/0019-5049.135024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- S Bala Bhaskar
- Department of Anaesthesiology and Critical Care, Vijayanagar Institute of Medical Sciences, Bellary, Karnataka, India. E-mail:
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12
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Sehgal V, Bajwa SJS, sehgal R, Eagan J, Reddy P, Lesko SM. Predictors of acute kidney injury in geriatric patients undergoing total knee replacement surgery. Int J Endocrinol Metab 2014; 12:e16713. [PMID: 25237322 PMCID: PMC4166005 DOI: 10.5812/ijem.16713] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 03/16/2014] [Accepted: 03/22/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Few studies have focused on patients' characteristics that affects acute kidney injury (AKI) after total knee replacement surgery (TKR). OBJECTIVES The primary objective of this retrospective study was to identify patients' characteristics associated with AKI after TKR. PATIENTS AND METHODS Between January 2008 and December 2009, 659 patients with a mean age of 67.1 years (range, 39-99) underwent TKA at Regional Hospital Knee and Hip Institute. Retrospective chart review was done to identify patients' characteristics that were associated with AKI after TKR. Logistic regression was used to evaluate AKI. RESULTS AKI occurred in 21.9% of patients. AKI risk decreased between 2008 and 2009 (odds ratio, 0.55; 95% CI, -0.37 to 0.82) but increased with age (P < 0.001), diabetes mellitus (DM), and angiotensin converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) use (OR, -1.6; 95% CI, -1.0 to 2.5; and OR, -1.5, 95% CI, -1.0 to 2.3, respectively). However, the effects of DM and ACEI/ARB use were not independent; when both were included in the regression model, neither was statistically significant, and both ORs were smaller than combined OR. CONCLUSIONS When examined separately, both DM and preoperative ACEI/ARB use increased the risk of AKI; however these factors were correlated and were not independent predictors of significantly increased risk. Patients with DM have higher tendency to develop AKI and hence, preoperative renal risk stratification should be done in all patients with DM.
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Affiliation(s)
- Vishal Sehgal
- Department of Internal Medicine, University of South Carolina.Greenville, South Carolina, USA
| | - Sukhminder Jit Singh Bajwa
- Department of Anesthesiology and Intensive Care Medicine, Gian Sagar Medical College, Banur, Patiala, Punjab, India
- Corresponding author: Sukhminder Jit Singh Bajwa, Department of Anesthesiology and Intensive Care Medicine, Gian Sagar Medical College, Banur, Patiala, Punjab, India. Tel: +99-15025828, +91-1752352182, Fax: +86-47976115, E-mail:
| | - Rinku sehgal
- Department of Internal Medicine, Wright Center, Scranton, USA
| | - Jeremiah Eagan
- Department of Nephrology, Regional Hospital, Scranton, USA
| | - Praveen Reddy
- Department of Internal Medicine, Wright Center, Scranton, USA
| | - Samuel M. Lesko
- Northeast Regional Cancer Institute, University of Scranton, Scranton, USA
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Dietary supplements and the anesthesiologist: Research results and state of the art. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2014. [DOI: 10.1016/j.rcae.2014.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Franco Ruiz S, González Maldonado P. Los suplementos dietéticos y el anestesiólogo: resultados de investigación y estado del arte. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2014. [DOI: 10.1016/j.rca.2014.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Dietary supplements and the anesthesiologist: Research results and state of the art☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2014. [DOI: 10.1097/01819236-201442020-00004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Sehgal V, Bajwa SJS, Sehgal R, Bajaj A. Clinical conundrums in management of hypothyroidism in critically ill geriatric patients. Int J Endocrinol Metab 2014; 12:e13759. [PMID: 24719636 PMCID: PMC3968976 DOI: 10.5812/ijem.13759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 09/22/2013] [Accepted: 09/24/2013] [Indexed: 12/31/2022] Open
Abstract
CONTEXT Articles in various international and national bibliographic indices were extensively searched with an emphasis on thyroid and hypothyroid disorders, hypothyroidism in elderly hospitalized patients, hypothyroidism in critically ill geriatric population, thyroxine in elderly hypothyroid, drug interactions and thyroid hormones, and thyroid functions in elderly. EVIDENCE ACQUISITION Entrez (including PubMed), NIH.gov, Medscape.com, WebMD.com, MedHelp.org, Search Medica, MD consult, yahoo.com, and google.com were searched. Manual search was performed on various textbooks of medicine, critical care, pharmacology, and endocrinology. RESULTS Thyroid function tests in elderly hospitalized patients must be interpreted with circumspection. The elderly are often exposed to high iodide content and critical care settings. This may occur because of either decreased iodine excretion or very high intake of iodine. This is especially true for elderly population with underlying acute or chronic kidney diseases or both. Amiodarone, with a very high iodine content, is also often used in this set of population. Moreover, other medications including iodinated contrast are often used in the critical care settings. These may affect different steps of thyroid hormone metabolism, and thereby complicate the interpretation of thyroid function tests. CONCLUSIONS The current review is aimed at analyzing and managing various clinical aspects of hypothyroidism in hospitalized elderly, and critically ill geriatric patients.
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Affiliation(s)
- Vishal Sehgal
- The Commonwealth Medical College, Scranton, PA, USA
- Corresponding author: Vishal Sehgal, Department of Medicine, The Common wealth Medical College, Scranton, PA, USA, E-mail:
| | - Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care Medicine, Gian Sagar Medical College, Banur, Patiala, India
| | - Rinku Sehgal
- The Wright Center for Graduate Medical education, Scranton, PA, USA
| | - Anurag Bajaj
- The Wright Center for Graduate Medical education, Scranton, PA, USA
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