Chapter 15
- Complementary and Alternative Therapies
- Michael Ang-Lee
- Chun-Su Yuan
- Jonathan Moss
Complementary and alternative medicine (CAM) has implications
for physicians in general but has particular importance for perioperative physicians
because of complications associated with the use of certain therapies and their roles
as anesthesia adjuvants. The rapidly rising number of patients using CAM therapies
mandates knowledge of them by anesthesiologists. In 1997, 42.1% of Americans used
CAM therapies, a significant increase from 33.8% in 1990.[1]
Visits to CAM practitioners now exceed those to American primary care physicians,
[1]
and CAM is even more widely used in Europe,
where
herbal medicines are more frequently prescribed than conventional drugs in many situations.
Of particular relevance for anesthesiologists is that patients undergoing surgery
appear to use CAM more than the general population.[2]
Despite the public enthusiasm for CAM, scientific knowledge in
this area is still incomplete and often confusing for practitioners and patients.
Recommendations for clinicians are often based on small clinical trials, case reports,
animal studies, predictions derived from known pharmacology, and expert opinion.
Research is essential because CAM therapies are often widely adopted by the public
before there are adequate data to support their safety and efficacy. In 1991, Congress
established the Office of Alternative Medicine, which became the National Center
for Complementary and Alternative Medicine within the National Institutes of Health
in 1998. In 2001, nearly three times as many CAM-related English-language research
articles were published as in 1991.
The practices encompassed by CAM are heterogeneous and are evolving
as CAM therapies are integrated into conventional medicine (e.g., diet, exercise,
behavioral medicine). CAM practices can be classified into five general categories
[3]
( Table
15-1
). This chapter is not intended as a comprehensive review of CAM.
Specific therapies relevant to anesthesia are discussed, and we focus primarily
on herbal medicines. Nonherbal dietary supplements, acupuncture, and music are also
examined.
