Perioperative adverse events and Chinese herbal medicine

[Guest guest]

1: Anesthesiology. 2006 Sep;105(3):454-461.

 

Incidence and Risk of Adverse Perioperative Events among Surgical

Patients

Taking Traditional Chinese Herbal Medicines.

 

Lee A, Chui PT, Aun CS, Lau AS, Gin T.

 

* Associate Professor, dagger Consultant Anaesthetist, double dagger

Professor,

section sign Research Nurse.

 

BACKGROUND:: The use of traditional Chinese herbal medicines (TCHMs)

among the

presurgical population is widespread, but their impact on perioperative

patient

care is unclear. The authors estimated the incidence and risk of

TCHM-related

perioperative events. METHODS:: In a Hong Kong cohort study, 601

patients

undergoing major elective surgery were asked about their Western

medicine and

TCHM use in the 2 weeks before surgery. Unanticipated perioperative

events were

noted by attending anesthesiologists, blinded to patients' use of

specific

TCHMs. Modified Poisson regression models were used to obtain the

relative risk

of combined endpoints of perioperative events associated with TCHM use.

RESULTS:: Of the 601 patients, 483 patients (80%) took self-prescribed

TCHM, and

47 (8%) took TCHM by prescription (with or without self-prescribed

TCHM) in the

2 weeks before surgery. The crude incidences of any combined endpoints

of

preoperative, intraoperative, and postoperative events were 23% (95%

confidence

interval, 19-26%), 74% (95% confidence interval, 71-78%), and 63% (95%

confidence interval, 59-66%), respectively. Compared with nonusers,

patients who

took TCHM by prescription were more likely to have a preoperative event

(adjusted relative risk, 2.21; 95% confidence interval, 1.14-4.29). The

authors

present four case reports to highlight the effect of TCHM by

prescription on

prolonged activated partial thromboplastin time and hypokalemia in the

preoperative period. In contrast, there was no significant association

between

the use of any type of TCHM and the occurrence of either intraoperative

or

postoperative events. CONCLUSIONS:: The use of TCHM by prescription

near the

time of surgery should be discouraged because of the increased risk of

adverse

events in the preoperative period.

 

PMID: 16931976 [PubMed - as supplied by publisher]

 

 

 

Stephen Bonzak, M.S., L.Ac., Dipl. Ac. & C.H.

Assistant Professor, Department of Herbal Medicine

Pacific College of Oriental Medicine - Chicago

sbonzak

773-470-6994

[Guest guest]

80% of the patients taking CHM were self-medicating?

and only 8% had a prescription from a herbalist?

Seems a bit odd to recommend people not take CHM - maybe a more

sensical recommendation would be for patients to take herbs on

prescription...

 

(and maybe some of the surgeries could be avoided in this manner...)

 

And - what kind of perioperative events are we talking here?

 

Tim.

 

, Stephen Bonzak

<smb021169 wrote:

>

> 1: Anesthesiology. 2006 Sep;105(3):454-461.

>

> Incidence and Risk of Adverse Perioperative Events among Surgical

> Patients

> Taking Traditional Chinese Herbal Medicines.

>

> Lee A, Chui PT, Aun CS, Lau AS, Gin T.

>

> * Associate Professor, dagger Consultant Anaesthetist, double

dagger

> Professor,

> section sign Research Nurse.

>

> BACKGROUND:: The use of traditional Chinese herbal medicines

(TCHMs)

> among the

> presurgical population is widespread, but their impact on

perioperative

> patient

> care is unclear. The authors estimated the incidence and risk of

> TCHM-related

> perioperative events. METHODS:: In a Hong Kong cohort study, 601

> patients

> undergoing major elective surgery were asked about their Western

> medicine and

> TCHM use in the 2 weeks before surgery. Unanticipated perioperative

> events were

> noted by attending anesthesiologists, blinded to patients' use of

> specific

> TCHMs. Modified Poisson regression models were used to obtain the

> relative risk

> of combined endpoints of perioperative events associated with TCHM

use.

> RESULTS:: Of the 601 patients, 483 patients (80%) took self-

prescribed

> TCHM, and

> 47 (8%) took TCHM by prescription (with or without self-prescribed

> TCHM) in the

> 2 weeks before surgery. The crude incidences of any combined

endpoints

> of

> preoperative, intraoperative, and postoperative events were 23%

(95%

> confidence

> interval, 19-26%), 74% (95% confidence interval, 71-78%), and 63%

(95%

> confidence interval, 59-66%), respectively. Compared with nonusers,

> patients who

> took TCHM by prescription were more likely to have a preoperative

event

> (adjusted relative risk, 2.21; 95% confidence interval, 1.14-4.29).

The

> authors

> present four case reports to highlight the effect of TCHM by

> prescription on

> prolonged activated partial thromboplastin time and hypokalemia in

the

> preoperative period. In contrast, there was no significant

association

> between

> the use of any type of TCHM and the occurrence of either

intraoperative

> or

> postoperative events. CONCLUSIONS:: The use of TCHM by prescription

> near the

> time of surgery should be discouraged because of the increased risk

of

> adverse

> events in the preoperative period.

>

> PMID: 16931976 [PubMed - as supplied by publisher]

>

>

>

> Stephen Bonzak, M.S., L.Ac., Dipl. Ac. & C.H.

> Assistant Professor, Department of Herbal Medicine

> Pacific College of Oriental Medicine - Chicago

> sbonzak

> 773-470-6994

>