Herbal Medicines in Perioperative Care: From Herb-Drug Interactions to a Risk-Stratified Medication-Reconciliation Framework
Keywords:
Anesthesia, Bleeding Risk, Herb-Drug Interactions, Herbal Supplements, Medication Reconciliation, Perioperative CareAbstract
Herbal products are reported by surgical patients, but medication histories may omit the formulation, dose, and time of last use. This narrative mini-review examines how such uncertainty affects perioperative risk assessment. We prioritized literature published from January 2020 through December 2025 and included earlier interaction studies and 2026 professional guidance. Potential hazards include altered hemostasis, drug metabolism and transport, sedation, cardiovascular and metabolic effects, and product contamination; clinical importance depends on the preparation, concurrent medicines, and planned procedure. Evidence of perioperative benefit is limited, and findings from small clinical studies or animal models do not justify routine use. We propose an unvalidated medication-reconciliation workflow that records product identity and exposure, considers mechanisms alongside patient and procedural vulnerability, and assigns a provisional low, moderate, high, or uncertain action category. Uncertain exposure calls for label verification and clinical review, especially before emergency or bleeding-sensitive procedures. Discontinuation and postoperative reintroduction should be individualized because one stop interval cannot be applied to all products. The workflow requires prospective evaluation, as do the effects of chemically characterized preparations on surgical outcomes.
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