St. John's Wort
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| Have there been any reported complications with the use of St. John's Wort and Anesthesia? Patients are taking many of these OTC nutritional products. In a current editorial in Aesthetic Surgery Journal, November/December 1998, vol. 18, no. 6 pp. 442-443 a warning is given about the MAOI (monoamine oxidase inhibitory effect) of hypercium. The editorial stated that St. John's Wort, yohimbe and licorice root all have a MAOI activity. Recommendations were given to "discontinue the use of these supplements 2 weeks before surgery, and that they should not be used simultaneously with meperidine". This causes great concern with elective surgery especially with liposuction where large amounts of fluid (.9%NS, lidocaine and epinephrine) are infused. The biggest concern is not only during surgery but post-op. There can be large fluid shifts and third spacing of fluid for several days.
Can the MAOI activity precipitate hypertensive or hypotensive problems? Are there any current recommendations? What is the therapeutic dose of St. John's Wort? (I understand that it is 900mg of .3% hypercium). Would subclinical doses also cause reason for concern? Suggestions or comment much appreciated.
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