Traditional Chinese herbal medicine and anaesthesia

An increasing number of people in the western world are using traditional Chinese herbal medicines. There are concerns that these Chinese medicines may contain potentially toxic ingredients and contaminants such as heavy metals. Undeclared conventional western drugs such as the nonsteroidal anti-inflammatory and antihistamine drugs, steroids and oral hypoglycaemic agents are frequently added to Chinese herbal medicines. The constituents of the herbal products can cause adverse effects. The anaesthetist should be aware of the potential adverse effects of the herbal products, their contaminants and also of undeclared additives. The potential for drug interactions, coagulopathy and organ dysfunction caused by traditional Chinese herbal medicines has important anaesthetic implications.