Perioperative considerations in the management of the patient taking herbal medicines.

The use of herbal products has recently increased dramatically in the United States. Patients are flocking to use these and many other complementary or alternative therapies. Perhaps disillusionment with managed care, loss of the traditional doctor-patient relationship, or simply increased access on store shelves, in the media, and on the Internet have all led to this increased use. As physicians, we are facing a paucity of information regarding the true dangers of these products, and there is virtually no information on how they may affect the perioperative milieu. The following review will discuss the limitations of Food and Drug Administration protection, and will review as well as provide an outline of the potential adverse reactions and side-effects that might affect anesthesia administration. To date, no double-blind, placebo-controlled studies have been carried out that specifically address herbal-anesthetic interactions or outcomes.