Supplemental Online Lesson

Lesson S10: PreAnesthetic Assessment of the Patient Using Herbal Therapies

Registration Fee: $15.00
2.0 AMA PRA Category 1 Credits^TM

Release Date: January 1st, 2010
 Termination Date: January 31st, 2011

Click on the link below to download and print the course material and post-test exam.  Register for the exam to enter your responses to receive CME credit.  There are ten questions in the examination and you must achieve a score of 80% or better to earn CME credit.  Following successful completion, your certificate will be immediately available online.  In addition, a historical record of  completed CME courses is maintained online in an individualized profile.  This includes copies of course certificates which can be printed at any time.

The registration fee for this course is $15.00

Physicians are provided with two opportunities to successfully complete the exam presented here. 

Software Requirements: Adobe Acrobat Reader and any standard Internet Browser.

Herbal, supplemental and alternative therapies can have negative effects in presurgical patients. Patients are most likely to consider herbs to be “safe” and “natural” and infrequently view herbs as harmful drugs. The Food and Drug Administration (FDA) does not regulate herbal preparations in the same strict manner as pharmaceuticals and there is no control on the amount of active ingredients in most of these preparations. Anesthesiologists must be aware that drug interactions can occur, especially during the perioperative period. Physicians need to be equipped with the knowledge of potential problems so that patients may be appropriately advised.

This two part series will review the impact of herb therapy on the surgical population. Complications and drug interactions associated with specific herb therapies are addressed. A short historical outline as well as government regulations and special advisories are presented.

During a preoperative evaluation, a 76-year-old Asian female for total hip replacement revealed that she was regularly ingesting a variety of herbs to treat depression and to season food. She possessed several capsules of Kava kava and St John’s Wort. She reported the use of ginger, ginko and ginseng daily. The patient stated that her surgeon and primary care physician were not informed about her regular use of these herbal substances as she did not regard them as medicine. Physical examination showed a mildly obese female weighing 90 kg with poor dentition and recent episodes of gingival bleeding. Preoperative laboratory tests showed a hemoglobin of 9.0 gm/dl. A bleeding time was found to be abnormal at 16 minutes. Both PT and PTT were elevated.

LEARNING OBJECTIVES

At the end of this activity, the participant should be able to:

1. Differentiate between drugs and herbs.

2. Be aware of government regulations regarding herb preparation and labeling.

3. List the most commonly used herbs.

4. Define “herbal”.

5. Be conversant with a short history of herbal medicine.

6. Outline the epidemiology and prevalence of herb use in the United States.

7. Describe an herbal salt substitute.

8. List reasons for the herbal renaissance.

9. Cite the annual expenditure on herb preparations in the United States.

10. Identify sources of information regarding herbal treatments.

TARGET AUDIENCE:  Anesthesiologists

Accreditation Statement

Mount Sinai School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation: The Mount Sinai School of Medicine designates each educational activity for a maximum of 2 AMA PRA Category 1 Credits^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

It is the policy of Mount Sinai School of Medicine to ensure objectivity, balance, independence, and scientific rigor in all CME-sponsored educational activities. All faculty participating in the planning or implementation of a sponsored activity are expected to disclose to the audience any relevant financial relationships and to assist in resolving any conflict of interest that may arise from the relationship. Presenters must also make a meaningful disclosure to the audience of their discussions of unlabeled or unapproved drugs or devices.

Disclosures

The author, reviewer, and editor have no relationships with pharmaceutical companies or manufacturers of products to disclose. This educational activity may contain discussion of published and/or investigational uses of agents for the treatment of disease. Some uses of these agents have not been approved by the FDA. Please refer to the official prescribing information for each product for approved indications, contraindications, and warnings.

CONTACT INFORMATION

Questions regarding course content may be directed to Dr. Elizabeth Frost: ElzFrost@aol.com.

If you require technical assistance with completing this course, please contact Continuing Education Online Customer Service at 718-648-8080 or send e-mail to ceo.contact7@proceo.com.

CALL FOR WRITERS

If you would like to write a CME lesson in Anesthesiology News, please send an e-mail to Elizabeth A.M. Frost, MD, at ElzFrost@aol.com