During a preoperative medical history evaluation, it is critical to explicitly inquire about the use of over-the-counter dietary and herbal supplements. Patients frequently omit these substances from their medication lists unless directly prompted, despite their potential to cause significant systemic and perioperative complications. Match each herbal supplement below to the clinical complication most likely to be established if the patient continues its use immediately prior to undergoing surgery.
- Ginkgo bilobaIncreased risk of perioperative hemorrhage due to platelet inhibition
- Kava extractSevere hepatotoxicity or fulminant hepatic failure
- YohimbineHypertensive crisis and significant tachycardia
- Valerian rootProlonged emergence from general anesthesia due to enhanced sedation
Answer
Ginkgo biloba matches with increased risk of perioperative hemorrhage; Kava extract matches with severe hepatotoxicity; Yohimbine matches with hypertensive crisis; Valerian root matches with prolonged emergence from anesthesia.
Each supplement possesses a distinct pharmacologic profile that dictates its specific perioperative risk. Ginkgo biloba causes bleeding via platelet inhibition. Kava extract is directly toxic to the liver. Yohimbine acts as a stimulant by antagonizing alpha-2 receptors, leading to catecholamine excess. Valerian root acts as a central nervous system depressant by potentiating GABAergic pathways.
Step-by-Step Solution
Key Concept
Thorough preoperative medical history evaluation must include specific inquiries about herbal supplements to anticipate and prevent adverse intraoperative and postoperative events based on their distinct pharmacologic mechanisms.