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Pediatric perioperative clinical pharmacists are uniquely positioned to provide therapeutic and medication management expertise at a particularly vulnerable transition of care from the preoperative space, through surgery, and postoperative setting. There are many direct-patient care activities that are included in the role of the pediatric perioper...
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... Maximal allowable blood loss for any surgery is calculated by using the following equation: in which "Hb initial" is starting hemoglobin, "Hb low" is the lowest acceptable hemoglobin threshold without red cell transfusion, and "EBV" is the patient's estimated circulating blood volume. Table 2 lists the estimated circulating blood volume by patient age. Surgeries associated with higher blood volume loss in children include cardiac, liver transplant, scoliosis, craniosynostosis, and trauma-related surgeries. ...Context 2
... Maximal allowable blood loss for any surgery is calculated by using the following equation: in which "Hb initial" is starting hemoglobin, "Hb low" is the lowest acceptable hemoglobin threshold without red cell transfusion, and "EBV" is the patient's estimated circulating blood volume. Table 2 lists the estimated circulating blood volume by patient age. Surgeries associated with higher blood volume loss in children include cardiac, liver transplant, scoliosis, craniosynostosis, and trauma-related surgeries. ...Similar publications
Considering a rejection rate of 80-90%, the preparation of a research grant is often considered a daunting task since it is resource intensive and there is no guarantee of success, even for seasoned researchers. This commentary provides a summary of the key points a researcher needs to consider when writing a research grant proposal, outlining: (1)...
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... 8 Pharmacists play pivotal role in huge spectrum of cardiovascular services in pediatric patients encompassing arrhythmia management, heart failure care, management of hypertension, anti-coagulation clinics, comprehensive handling of Kawasaki disease in collaboration with physician and expansion of pharmacist role in extracorporeal cardiopulmonary resuscitation in optimizing medication strategy during pediatric cardiac arrest. [9][10][11][12] In realm of pediatric cardiac surgeries pharmacist hold a distinctive position in preoperative to post-operative care by the development of meticulously designed, efficient, and safe utilization protocols. 10 And the implementation of pharmacist-led discharge medication counseling resulted in noteworthy improvement in medication adherence, minimizing medication discrepancies, and lower the number the hospital readmission linked to cardiovascular linked to cardiac problem in pediatric population. ...
... [9][10][11][12] In realm of pediatric cardiac surgeries pharmacist hold a distinctive position in preoperative to post-operative care by the development of meticulously designed, efficient, and safe utilization protocols. 10 And the implementation of pharmacist-led discharge medication counseling resulted in noteworthy improvement in medication adherence, minimizing medication discrepancies, and lower the number the hospital readmission linked to cardiovascular linked to cardiac problem in pediatric population. 13 ...
Pharmacists are universally regarded as an integral component in the therapeutic prescription, particularly within the realm in pediatric population. As the drastic increase in prevalence of cardiovascular diseases in pediatrics in Pakistan harness numerous opportunities for pharmacists to involve in clinical activities such as, to evaluate treatment regimens, therapeutic monitoring, adverse event monitoring, counseling and intervene as needed appropriately in collaboration with physician to facilitate high care to pediatric patients. However, a comprehensive literature review underscores the dearth of such patient-centered practice in Pakistan in public-health sector specially. In this commentary, we accentuate the indispensable involvement of pharmacist in pediatric cardiac unit of public-sector in low and middle income country to optimized pediatric patients care
... This will become particularly important once guidelines for pediatric surgeries are further developed. 34,35 Third, many studies used to validate guidelines are based on literature that mention the medication name as a study drug, but not the dose or regimen used or the timing of administration. An exception would include the inclusion of dosage and route for certain antiemetics and multimodal pain management agents. ...
Introduction: Worldwide, ERAS® Society guidelines have ushered in a new era of perioperative care. The purpose of this systematic review is to compare published core elements and pharmacotherapy recommendations embedded within ERAS® Society abdominal and thoracic surgery (ATS) guidelines. Determining whether a consensus exists for pharmacological
core items would make future guideline preparation for similar surgeries more standardized and could improve patient care by reducing unnecessary protocol variations.
Methods: From the ERAS® Society website as of May 2023, 16 current ERAS® published ATS guidelines were included in the analysis to determine consensus and differing statements regarding each ERAS® perioperative and pharmacotherapy‐related item. The aims were to (a) determine whether a consensus for each item could be derived, (b) identify gaps in ERAS® protocol development, and (c) propose potential research directions
for addressing the identified gaps in the literature.
Results: Core items with consensus included: preoperative smoking and alcohol cessation; avoiding bowel reparation and fasting; multimodal preanesthetic, perioperative analgesia, and postoperative nausea and vomiting regimens; low molecular weight heparins for in‐hospital and at‐home venous thromboembolism prophylaxis; antibiotic prophylaxis; skin preparation; goal‐directed perioperative fluid management with balanced crystalloids; perioperative nutrition care; ileus prevention with peripherally‐acting mu receptor antagonists; and glucose control.
Conclusion: While consensus was found for aspects of 21 current ERAS® guideline core items related to pharmacotherapy choice, details related to doses, regimen, timing of administration as well as unique aspects pertaining to specific surgeries remain to be researched and harmonized to promote guideline consistency and further optimize patient outcomes.
... A list of the common surgery-related drugs is formulated. Considering different diseases, surgical types, special populations and other factors, the process and focus of medication therapy management should be adjusted individually, and the whole-course medication therapy plan and working pathway of ERAS suitable for the hospital should be developed jointly with doctors [104,105]. In addition, surgical pharmacists can provide drug consultation and training to ERAS teams from the perspective of drug treatmentrelated issues, such as drug safety, drug interactions, adverse drug reactions, and drug use characteristics in specific populations. ...
Drug-related problems (DRPs) are common among surgical patients, especially older patients with polypharmacy and underlying diseases. DRPs can potentially lead to morbidity, mortality, and increased treatment costs. The enhanced recovery after surgery (ERAS) system has shown great advantages in managing surgical patients. Medication therapy management for surgical patients (established as “surgical pharmacy” by Guangdong Province Pharmaceutical Association (GDPA)) is an important part of the ERAS system. Improper medication therapy management can lead to serious consequences and even death. In order to reduce DRPs further, and promote the rapid recovery of surgical patients, the need for pharmacists in the ERAS program is even more pressing. However, the medication therapy management services of surgical pharmacy and how surgical pharmacists should participate in ERAS programs are still unclear worldwide. Therefore, this article reviews the main perioperative medical management strategies and precautions from several aspects, including antimicrobial agents, antithrombotic agents, pain medication, nutritional therapy, blood glucose monitoring, blood pressure treatment, fluid management, treatment of nausea and vomiting, and management of postoperative delirium. Additionally, the way surgical pharmacists participate in perioperative medication management, and the relevant medication pathways are explored for optimizing medication therapy management services within the ERAS programs. This study will greatly assist surgical pharmacists’ work, contributing to surgeons accepting that pharmacists have an important role in the multidisciplinary team, benefitting medical workers in treating, counseling, and advocating for their patients, and further improving the effectiveness, safety and economy of medication therapy for patients and promoting patient recovery.
Medical emergencies arising in the perioperative period can have unique etiologies, medication management, and care complexities. Clinical pharmacists have established roles and demonstrated value in resuscitative efforts elsewhere within acute care settings, but very little published description of pharmacist participation in perioperative emergency response is currently available. Furthermore, specialized clinical and operational knowledge may be needed to effectively optimize medication use during a perioperative medical crisis. This narrative review offers recommended pharmacist roles, concise pharmacotherapeutic considerations, and key resources to support clinical pharmacists in all facets of perioperative medical emergency management and preparedness. Specific medical crises discussed include malignant hyperthermia, local anesthetic systemic toxicity, intraoperative cardiac arrest, anaphylaxis, carcinoid crisis, pheochromocytoma, and vasoplegia. Additional pharmacy practice studies are needed to validate clinical pharmacists as essential members of perioperative emergency response teams and delineate their associated impact on patient outcomes in this setting. This article is protected by copyright. All rights reserved.
