Anaesthesia Coffee Break Alternative medications and anaesthesia with Dr Mandy
Feb 21, 2022
In this engaging conversation, Dr. Mandy Baric, an experienced anaesthetist and educator from Melbourne, explores the intriguing world of alternative medications in anaesthesia. She highlights the importance of patients disclosing herbal use and discusses the pharmacological interactions, especially with cytochrome P450. Key topics include the risks of St John's Wort, insights on ginseng, garlic, and other 'G herbs', and practical advice for anaesthetists on managing herbal histories. Mandy’s expertise shines as she navigates these complex interactions to improve perioperative care.
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Avoid St John's Wort Perioperatively
- Stop St John's Wort before surgery because it induces CYP450 and affects serotonin.
- Consider at least five days off, with two weeks as a safe blanket period when practical.
Be Cautious With Tramadol
- Use alternatives to tramadol if a patient is on St John's Wort and monitor closely if tramadol is needed.
- Expect possible delayed emergence or drowsiness from St John's Wort and manage conservatively.
The 'G' Herbs Share Bleeding Risks
- G-group herbs (garlic, ginseng, ginger, ginkgo) commonly have antiplatelet effects, but impact is dose dependent.
- Assess formulation and dose rather than assuming uniform risk across patients.