Eric G. Johnson

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.