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Herbal medicines are composed of the biologically active components of plants or parts of plants, such as seeds, roots, or flowers, for medicinal purposes. Although herbal medicines have been used for centuries in Chinese and Ayurvedic medicine, their use has dramatically increased for primary health care over the past few years. The World Health Organization estimates that 80% of the people worldwide use alternative and herbal medications as part of their health-care regimen. Awareness of the rising use of these alternative medicines is important to prevent, recognize, and treat potential perioperative problems.


Patients often take a combination of prescription and herbal medications, which can cause adverse reactions in the perioperative period (Table 47-1). Both patients and physicians frequently underestimate the risks associated with drug and herbal medication interactions, particularly interactions affecting coagulation. Preoperative consultation should include screening for the use of herbal medicines and the potential interactions with prescription medications. It is recommended that most herbal medications be discontinued at least 2-3 weeks prior to anesthesia or elective surgery.

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TABLE 47-1Effects of Commonly Used Herbal Medications

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