Management of patients taking herbal medicines in the perioperative period: a survey of practice and policies within Anaesthetic Departments in the United Kingdom

Abstract

Patients commonly take a combination of prescription drugs and herbal medicines. Often these alternative products have known pharmacological effects which may interact with drugs given perioperatively, resulting in adverse events. They can also cause physiological fluctuations which may influence the choice of anaesthetic technique used. This has been acknowledged by a number of national bodies that recommend eliciting a history of herbal medicine use preoperatively. This survey attempted to ascertain whether this guidance had been observed and turned into local policy. We also attempted to determine what advice patients were being given. Three hundred and twenty-one questionnaires were sent to all United Kingdom hospitals with an Anaesthetic Department in September 2006. Reminders were then sent to those recipients who did not respond. Replies were received from 233 (72.6%) anaesthetic departments. Seventeen (7.3%) departments have a perioperative herbal medicine policy in place and a further six had plans to develop one. The majority (98.3%) of departments did not have a specific section for documenting herbal medicine use on their an aesthetic records. Of the departments that held pre-assessment clinics, 34 (15.7%) asked patients routinely about herbal medicine use, and the advice given regarding the use of herbal medicines was varied, and generally, not in accordance with existing guidelines. Anaesthetic departments in the United Kingdom are not currently following national advice regarding herbal medicine use. There is no coherence in the advice being offered to patients in the perioperative period, which may reflect the lack of information available. National guidelines may help clinicians understand the issues and adopt best practice.