پاورپوینت کامل HERBAL MEDICINES ANESTHETIC IMPLICATIONS 63 اسلاید در PowerPoint

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پاورپوینت کامل HERBAL MEDICINES ANESTHETIC IMPLICATIONS 63 اسلاید در PowerPoint

اسلاید ۴: A 35 year old otherwise healthy mother of three presents for posterior lumbar fusion for chronic back pain that has failed conservative treatment. Because of her unremarkable history, her consultation in preop clinic was deferred. She is attended by her mother as she and her spouse are separated.

اسلاید ۵: A 35 year old athletic woman with a history of migraines presents for ACL reconstruction. History of PONV.FeverfewGinger

اسلاید ۶: ۳۵ year old for posterior spinal fusion.St. John’s Wort

اسلاید ۷: HERBAL MEDICINE HISTORYEarly archaeological evidence – Neanderthal16th Century Medicinal PlantsScientific method and the marginalization of Herbal Medicine – 19th CenturyRebirth of herbal medicine and natural health in the 1960’sEstablishment of Office of Alternative Medicine, National Institutes of Health 1992 1994 FDA Dietary Supplement and Health Education Act

اسلاید ۸: HERBAL MEDICINE EPIDEMIOLOGY3 – 93% of U.S. population use herbalsGenerally higher internationally

اسلاید ۹: Tsen, et al, Alternative medicine Use in Presurgical Patients, Anesthesiology, 93, 148-51Incidence of Herbal Medicine Use Among Age Groups% Age group

اسلاید ۱۰: Tsen, et al, Alternative medicine Use in Presurgical Patients, Anesthesiology, 93, 148-51n=3106

اسلاید ۱۱: Top Ten Selling Herbs 1995 Survey of 163 Health Food Retail Stores (Winslow and Kroll, 1998)ECHINACEAGARLICGOLDENSEALGINSENGGINKGOSAW PALMETTOALOEMA HUANGSIBERIAN GINSENGCRANBERRY(ST. JOHN’S WORT, VALERIAN, FEVER FEW)

اسلاید ۱۲: ECONOMICS AND REIMBURSEMENT$553 million in 8000 health food stores – 1994$ 1.2 billion from all sources20% annual growth ratelargest growth area in retail pharmaciesincreasing coverage of herbals and alternative therapies by insurance and managed care industries

اسلاید ۱۳: QUALITY CONTROL1994 Dietary Supplement and Health Education ActCompromise actNo requirements for:Proof of efficacyProof of safetyStandards for quality controlCannot promise a specific cure, but may claim effectBurden of proving product unsafe lies with FDA

اسلاید ۱۴: QUALITY CONTROLVariability between manufactures and batchesPotency affected by growing conditions, storage, handling, and preparation – up to 10,000 fold difference in potency

اسلاید ۱۵: QUALITY CONTROLInaccuracy of labelsContamination with other substancesMandrake(scopolamine) or Snakeroot (reserpine) in Ginseng preparationsUse of additives not found on label (NSAID’s, steroids, antibiotics, sedatives, hypnotics)Belladonna poisoning in herbal tea (NYC)Digitalis intoxication from mislabeled plant extractHeavy metals (lead, arsenic, cadmium, copper, mercury) in preparations from some foreign countries

اسلاید ۱۶: EFFICACY AND SAFETYNo profit in conducting controlled studies in U.S.Reported effects stem from anecdotal reports and a few well controlled clinical trialsSystem for reporting ADR’s for herbals and dietary supplements is poor (FDA web site available at:http://vPotential safety issues include:Drug-herb interactionsHerb-body interactions (inhibition or stimulation of microsomal liver enzymes)Toxicity from contaminantsDelayed intervention with allopathic treatment

اسلاید ۱۷: ORGAN SYSTEM TOXICITY (from Winslow and Kroll, 1998)GASTROINTESTINALHEPATOTOXIC (MILD TO SEVERE)Chinese herbal teas, Mistletoe, Germander, Chaparral, ComfreyNAUSEA/VOMITTINGDandelion, Garlic, Ginseng, ChaparralDIARRHEAHerbal teas, Aloe, Ligustrum, Dandelion, Prunelia, Garlic, GinsengHEMATOLOGICANTICOAGULANT/ANTIPLATELETYarrow, Red clover, Tang-kuei, Pau d’arco, Salvia

اسلاید ۱۸: ORGAN SYSTEM TOXICITY (from Winslow and Kroll, 1998)CENTRAL NERVOUS SYSTEMNERVOUSNESS / AGITATION/INSOMNIA / MOOD CHANGESDEPRESSION / CONFUSION / HALLUCINATIONSGinseng (long-term and higher doses)HALLUCINOGENICCatnip, Hops, Kava kava, Khat, Lobelia, Mandrake, Nutmeg, Jimson weed, Valerian, YohimbeCHOLINERGIC TOXICITY(CONTAINS ATROPINE, SCOPOLOMINE, HYOSCYAMINE)Jimson weedSEDATIONPeony, Salvia, Tang-kueiSEIZURES / PSYCHOSIS / COMAEphedra

اسلاید ۱۹: ORGAN SYSTEM TOXICITY (from Winslow and Kroll, 1998)PULMONARYPULMONARY HYPERTENSIONChinese herbal teasALLERGIC / IMMUNOLOGICCONTACT DERMATITISPropolis, Garlic, Echinacea, Melaleuca oilSYSTEMIC LUPUS ERYTHEMATOSISAlfalfaRENALDIURESISBurdock, Astragalus, Peony, DandelionHYPERTENSION / SODIUM AND WATER RETENTION / HYPOKALEMIALicorice, Glycyrrhiza glabra, Glycyrrhiza radix

اسلاید ۲۰: ORGAN SYSTEM TOXICITY (from Winslow and Kroll, 1998)ENDOCRINOLOGICGYNECOMASTIA / VAGINAL BLEEDINGGinseng (est