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Perioperative management of diabetes: Translating evidence into practice.

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Many patients do not tell their doctor about dietary supplements they may be taking, in part because physicians may not be as knowledgeable about supplements, and patients may fear the physician will be unhappy about the patient using nonconventional therapy.

However, doctors and nurses need to know if the patient is taking any supplements because the risk of complications from herbal supplements may be elevated in the perioperative period. The Journal of the American Medical Association.28-16. Advanced[1]Cardiovascular Life Support (ACLS) Provider Manual, 36, 38 - 45, . ASA Physical Status Classification System Hagberg, C. Benumof’s Airway Management, 2nd Ed.736-737 American Society of Anesthesiologists Task Force on Sedation and Analgesia by on Anesthesiologists. Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists.

Rare complications that might in part be due to supplements include myocardial infarction and stroke (i.e. As a result it is generally recommended to avoid herbal supplements for 2 weeks prior to a surgical procedure and anesthesia. Monitoring should be in place and clinicians should always be prepared to rescue patients who move to the next, deeper level of sedation.

ephedra) liver injury (i.e., echinacea,kava), ineffective anticoagulation and bleeding (i.e. The following is a list of common supplements that are of particular concern with regard to the perioperative period. Standard Monitoring The standard monitoring parameters for sedated patients specified in the ASGE Guidelines for Conscious Sedation and Monitoring during Gastrointestinal Endoscopy include measurement and recording of: Cardiopulmonary complications (intra- and post-procedural) Cardiopulmonary events related to sedation and analgesia is the most frequent cause of GI endoscopy-related morbidity/mortality.

Licorice and ginseng in particular have been associated with toxicities from overuse.

(FDA) has classified the following supplements as high risk and therefore need be avoided by all patients: Preprocedure assessment of herbals should commence in the primary care setting before the patient is actually referred to gastroenterology for a procedure.

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