As far as I know, the only good way to pitch-shift is to do a Fast Fourier Transform and apply a pitch shift that way. From some crude testing, the FFT took about 60 ms for 0.2 seconds of CD quality audio (in Rust on a decent laptop) which is significantly larger than the ~33 ms required for 30 fps, let alone the 17 ms for 60 fps and less for higher fpses. And to do that for a random pitch shift for an audio clip every time its played (for example a jump or attack sound effect) seems very inefficient.