Herbal Medications and Anesthesia Implications: A Clinical Practice Guideline

Abstract

Problem and Purpose: Herbal medications are widely used among the surgical population. Lack of reporting by patients and lack of preoperative questioning regarding herbal consumption can lead to perioperative complications. Overall, polypharmacy and physiological changes in regards to herbals can lead to serious herbal-drug interactions, hematological, cardiovascular, central nervous system, and drug metabolism side effects. Anesthesia providers need to be aware of these common herbal medications and their side effects in order to recognize and treat complications that could potentially arise. At an institution in Baltimore, Maryland, there is an herbal medication knowledge gap among anesthesia providers. The purpose of this clinical practice guideline (CPG) is to provide a resource on the common uses of herbal medications, their adverse effects, recommended discontinuation, and the anesthesia implications for patients undergoing surgery. Additionally, the CPG recommends the completion of a thorough herbal medication reconciliation during the preoperative evaluation. Methods: The CPG was developed by an interdisciplinary team of stakeholders consisting of two SRNAs, the chief CRNA, the associate chief anesthesiologist, one staff CRNA, and a pharmacist. The CPG was created based on a thorough review of the literature, with sources including MEDLINE, CINAHL, journals, and anesthesia reviews provided by large organizations. The CPG was graded through the completion of the AGREE II Instrument, which is a 23 item tool that evaluates guideline quality and comprehensiveness. The CPG was presented to staff via a presentation, and feedback was obtained from staff anesthetists through a Practitioner Feedback Questionnaire (PFQ). Results: During the development phase of the CPG, the AGREE II results were analyzed and edits were made accordingly. According to the PFQ, the total percentage of agreement was 91% overall. The total neutral and strongly disagree responses were 8% and 1.4% respectively. The calculated percent of agreement on quality, acceptance of recommendations, and applicability of recommendations were 95%, 90%, and 75% respectively. Overall, CPG approval and future use of recommendations were 100%. Conclusion: This CPG addresses a knowledge gap on herbal medications among anesthesia providers at a local institution. The CPG increases awareness and is a resource that has the potential to decrease perioperative complications resulting from herbal medication consumption.