During the preoperative assessment of a patient scheduled for a colon resection, the patient tells the nurse about using St. Johns wort to prevent depression. The nurse should alert the staff in the postanesthesia recovery area that the patient may

• A. experience increased pain.
• B. have hypertensive episodes.
• C. take longer to recover from the anesthesia.
• D. have more postoperative bleeding than expected.

Answer: (C)

St. John’s wort can significantly affect how drugs are handled by the body because it induces hepatic enzymes (notably CYP450 enzymes) and drug transporters. In the context of anesthesia, this means the medications used to induce and maintain anesthesia and to control pain and nausea may be metabolized and cleared more rapidly than usual. Anesthesiologists may need to adjust doses to achieve the desired effect, and after surgery, the combination of increased drug metabolism and any higher intraoperative dosing can lead to an unpredictable recovery trajectory. In some patients, this translates to a longer time to awaken and regain baseline function in the postanesthesia care area, so staff should be prepared for a potentially longer recovery period.

Other options don’t align as well with this interaction: the primary concern isn’t an inherent increase in pain, hypertensive episodes, or excessive postoperative bleeding related to this herb.