Impact on Perioperative Care: The use of Kava may have the biggest impact on a surgical patient after the procedure. Anesthesiologists understandably use a number of drugs that suppress the central nervous system and sedate the patient. Frequently benzodiazapines and barbiturates are utilized. Kava may potentiate the sedative effects of anesthetics and delay patient awakening postoperatively. Patients should discontinue to use Kava products at least 24 hours prior to surgery to prevent this complication.

The role of Kava in causing hepatotoxicity may influence drugs used by the anesthesiologist as well. As it is well known, the liver is responsible for most of the detoxification and metabolism of drugs. This is no different for anesthetic drugs, of which many are metabolized by the liver. If the patient is unaware of any pre-existing liver dysfunction and the Anesthesiologist has no reason to suspect it, then a patient could potentially enter surgery with some amount of liver dysfunction. This could lead to an increased duration of action of many drugs and more importantly, toxic levels. Because extensive research has not been performed to identify the risks of Kava in the surgical patient and Kava has not shown to be beneficial to the surgical patient, it would be best to err on the safe side and discontinue Kava use prior to surgery. If a question exists about liver function, LFT’s should be tested by the anesthesiologist during the preoperative evaluation.

It should also be noted that a sudden discontinuation of kava usage can result in a withdrawal syndrome.  Thus, it is recommended that patients using kava on a regular basis speak with their physician about a plan to taper their usage in the weeks prior to surgery to prevent any withdrawal symptoms.