As programs to increase the awareness of organ donation grow, more patients undergo cardiac transplantation. Because immunosuppressive therapy and postoperative care are improved, the 1-year survival rate of these patients has increased to more than 80%. Not surprisingly, these patients may, either coincidentally or as a result of medications, require other procedures using anesthesia, frequently at hospitals other than the highly specialized institution that performed the transplant. Because the denervated heart responds differently than the normal heart to many perioperative drugs, physicians, including cardiologists who are frequently consulted preoperatively, must have a special awareness of the particular problems in this group of patients.
Over the past 2 decades, the world health market has been flooded with over the counter herbal products, also known as nutraceuticals. Although many of these products are neither recommended nor prescribed by conventional medical practitioners, an increasing number of people are taking these products on a daily basis. A recent survey at Texas Tech University School of Medicine in Lubbock, Texas concluded that 32% of patients scheduled for elective surgery or pain procedures were taking one or more herbal supplements; however, 70% did not disclose these during a routine anesthetic assessment.(1) Pain physicians are also increasingly needed in the care of these patients. As many of these agents carry a potential to cause bleeding problems, we have reviewed here briefly, the basic mechanisms of coagulation and correlated the role of commonly used herbs known to possess side effects, which can cause excessive bleeding. In addition, we have reviewed a number of potential useful herbal derived agents for pain management.
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