After creating the position of surgical pharmacist in China,1 we have thought about the knowledge system of surgical pharmacists. Surgical pharmacists play a unique role in clinical practice, and so they must have a unique knowledge system, which we have named ‘surgical pharmacy’.
We defined surgical pharmacy as a discipline that studies the characteristics of perioperative medication, seeks the most suitable medication therapy, and addresses drug-related problems for perioperative patients, to improve the clinical outcome of these patients.
Consistent with the opinion stated in our published paper,1 we believe that surgical pharmacy involves the whole process of drug management during the perioperative period, and that medication therapy should be based on the clinical characteristics of perioperative patients, such as anti-infection, anti-thrombosis, analgesia, nutrition, blood glucose, blood pressure and liquid management, the treatment of postoperative nausea and vomiting (PONV), the use of glucocorticoids, and special drugs control.
Because of the stress reaction, the same clinical conditions may be managed in different ways from the differing therapeutic goals in surgery and internal medicine, which is the main focus of surgical pharmacy. For example, hyperglycaemia in the perioperative period may result from the stress reaction rather than diabetes. Incipient hyperglycaemia may be treated with oral hypoglycaemic drugs in endocrinology departments; however, insulin is the first choice medication for controlling perioperative hyperglycaemia. Some drugs are used differently in surgery and in internal medicine. For example, glucocorticoids are widely used in surgery for anti-stress reactions such as PONV, pain, airway responses and inflammation, which many physicians are unfamiliar with. Furthermore, surgical pharmacy should pay attention to perioperative medication for special populations, such as the elderly, children, pregnant women, and patients with liver or kidney dysfunction.
Preoperative preparation and postoperative follow-up of patients can be performed by pharmacists using the collaborative drug therapy management model, implementing medication reconciliation and deprescribing.1 If patients are on too many medications, they may not be suitable for surgery, therefore deprescribing is important for preoperative patients. Pharmacists also need to monitor medication effects during surgery. Consequently the pre-, mid- and postoperative medication therapy management services (MTMs) of perioperative patients are an important area of surgical pharmacy.
Surgical pharmacy should also pay attention to the management of special drugs such as narcotic drugs and psychotropic drugs, off-label use, and drugs that are prone to be used irrationally, such as proton pump inhibitors.
The establishment of surgical pharmacy was an important step for the Guangdong Province Pharmaceutical Association (GDPA) in promoting the extension of pharmacy services, which includes off-label use management, MTMs, pharmacist-managed clinics, and deprescribing, as described in previously published articles in this journal.2–4
In May 2021, the first textbook on surgical pharmacy compiled by the GDPA, intended for surgical pharmacist training and as a reference for surgeons was published by China Medical Science Press, one of the most important medical publishers in China.5 Based on the medication characteristics of different surgical specialties, we also tried to differentiate surgical pharmacy into diverse areas, such as oncology surgery and transplantation, and applied the concept of surgical pharmacy to the use of traditional Chinese medicine in surgery.
ejhpharm-2021-002887supp001.pdf (186KB, pdf)
Footnotes
Contributors: ZZ planned and wrote the manuscript. JW and LW collected the data. XL, BJ and HW reviewed the manuscript for critical content.
Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests: None declared.
Provenance and peer review: Not commissioned; internally peer reviewed.
Supplemental material: This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.
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References
- 1. Zheng Z, Wu J, Zeng Y, et al. Creating the position of surgical pharmacist in China. Eur J Hosp Pharm 2020;27:e99. 10.1136/ejhpharm-2020-002238 [DOI] [PMC free article] [PubMed] [Google Scholar]
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- 5. Wu J, Zeng Y, Wei L, et al. Surgical pharmacy. Beijing: China Medical Science Press, 2021. [Google Scholar]
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Supplementary Materials
ejhpharm-2021-002887supp001.pdf (186KB, pdf)