QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Résumé Full Text PDF Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Articles Ahead of Print [Order Reprint] Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lee, A. Articles by Lau, A. S. Search for Related Content PubMed PubMed Citation Articles by Lee, A. Articles by Lau, A. S.

Possible Interaction Between Sevoflurane and Aloe vera

Assistant Professor, Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China

Po Tong Chui, FANZCA

Consultant Anaesthetist, Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital

Cindy ST Aun, MD

Professor, Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital

Tony Gin, MD

Professor and Chairman, Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital

Angel SC Lau, BSN (Hons)

Research Nurse, Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital

OBJECTIVE: To describe a patient with massive intraoperative bleeding after oral consumption of Aloe vera tablets.

CASE SUMMARY: A 35-year-old woman lost 5 L of blood during surgery as a result of a possible herb–drug interaction between Aloe vera and sevoflurane.

DISCUSSION: Aloe vera is a common herb used for antiinflammatory and antiarthritic activity, as well as antibacterial, hypoglycemic, and lipid-lowering effects. Compounds contained within Aloe vera can cause a reduction in prostaglandin synthesis, which may inhibit secondary aggregation of platelets. Sevoflurane inhibits thromboxane A₂ formation by suppression of cyclooxygenase activity, impairs platelet aggregation, and prolongs bleeding. Although the vascularity and size of the hemangioma were the most important factors for the massive intraoperative blood loss, concomitant use of sevoflurane and Aloe vera played a contributory role. An objective causality assessment revealed that this adverse event was possible as a result of the sevoflurane and Aloe vera interaction.

CONCLUSIONS: There is a potential herb–drug interaction between Aloe vera and sevoflurane based on the antiplatelet effects of these 2 agents. Herbal medications with antiplatelet potential should be discontinued before anesthesia and surgery.

Key Words: Aloe vera, perioperative bleeding, sevoflurane

Published Online, August 3, 2004. www.theannals.com, DOI 10.1345/aph.1E098

This article has been cited by other articles:

				L. Howell, K. Kochhar, R. Saywell Jr, T. Zollinger, J. Koehler, C. Mandzuk, B. Sutton, J. Sevilla-Martir, and D. Allen Use of Herbal Remedies by Hispanic Patients: Do They Inform Their Physician? J Am Board Fam Med, November 1, 2006; 19(6): 566 - 578. [Abstract] [Full Text] [PDF]

				E. Fosslien Cardiovascular Complications of Non-Steroidal Anti-Inflammatory Drugs Ann. Clin. Lab. Sci., October 1, 2005; 35(4): 347 - 385. [Abstract] [Full Text] [PDF]