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  • Preoperative assessment of potential herbal medicine use is important for preoperative instruction and understanding of perioperative risks and complications
  • Dietary supplements and alternative medicines are exempt from FDA regulation:
    • Increasing usage, but are significantly underreported and often not addressed
    • Significant biological effects including:
      • Direct effects
      • Drug interactions: pharmacodynamic and pharmacokinetic
    • Ease of access without prescriptions
    • Variable manufacturing quality control standards (potency, contaminants)
    • Limited clinical studies
  • Of note, this chapter does not include nonherbal supplements such as vitamins, minerals, amino acids, or hormones
  • Many herbal medications have cardiovascular, coagulation, and sedative effects that may be associated with perioperative complications including MI, strokes, bleeding, and transplant rejection

Table 10-1 Herbal Medicines, Effects, and Anesthetic Implications

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