Pharmacologic management of the critically ill patient in the perioperative period--emphasis on the sepsis syndrome.

The critically ill perioperative patient requires complex pharmacologic management. The ability to measure circulating drug concentrations has helped the clinician to properly modulate therapy, especially with potentially toxic agents. Postoperative sepsis remains a difficult therapeutic problem. Controversial therapies, such as the use of corticosteroids and the utility of newer pharmacologic approaches, are beginning to be properly tested in multicenter trials. Improvements in technology (e.g., development of monoclonal antibodies), biochemistry, and pharmacology have resulted in the development of exciting, new pharmacologic avenues for the management of the critically ill perioperative patient.