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Vol. 64. Issue 8.
Pages 441-452 (October 2017)
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Vol. 64. Issue 8.
Pages 441-452 (October 2017)
Original article
National survey on postoperative care and treatment circuits in neurosurgery
Encuesta nacional sobre los circuitos de atención y tratamiento postoperatorio en neurocirugía
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R. Valeroa,
Corresponding author
rvalero@clinic.cat

Corresponding author.
, E. Carreroa, N. Fàbregasa, F. Iturrib, N. Saiz-Sapenac, L. Valenciad, Neuroscience Section of the Society of Anesthesiology, Intensive Care and Pain Therapy
a Servicio de Anestesiología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
b Servicio de Anestesiología, Hospital Universitario Cruces, Bilbao, Vizcaya, Spain
c Servicio de Anestesiología, Hospital 9 de Octubre, Valencia, Spain
d Servicio de Anestesiología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain
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Tables (7)
Table 1. First-line analgesics and associated drugs for postoperative pain management in neurosurgical interventions.
Table 2. Seizure prophylaxis in neurosurgery.
Table 3. Description of the composition the postoperative units and rate of admission of neurosurgical patients.
Table 4. Specialists responsible for the different neurosurgical postoperative monitoring units.
Table 5. Destination of patients in the immediate postoperative period and expected length of stay according to surgical intervention.
Table 6. Scheduled length of stay Postanaesthesia/Intermediate/Intensive Care Unit according to neurosurgical intervention.
Table 7. Postoperative neurological monitoring in neurosurgical patients according to type of surgery.
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Abstract
Introduction

The analysis of surgical processes should be a standard of health systems. We describe the circuit of care and postoperative treatment for neurosurgical interventions in the centres of our country.

Material and methods

From June to October 2014, a survey dealing with perioperative treatments and postoperative circuits after neurosurgical procedures was sent to the chiefs of Anaesthesiology of 73 Spanish hospitals with neurosurgery and members of the Neuroscience Section of SEDAR.

Results

We obtained 45 responses from 30 centres (41.09%). Sixty percent of anaesthesiologists perform preventive locoregional analgesic treatment. Pain intensity is systematically assessed by 78%. Paracetamol, non-steroidal anti-inflammatory and morphine combinations are the most commonly used. A percentage of 51.1 are aware of the incidence of postoperative nausea after craniotomy and 86.7% consider multimodal prophylaxis to be necessary. Dexamethasone is given as antiemetic (88.9%) and/or anti-oedema treatment (68.9%). A percentage of 44.4 of anaesthesiologists routinely administer anticonvulsive prophylaxis in patients with supratentorial tumours (levetiracetam, 88.9%), and 73.3% of anaesthesiologists have postoperative surveillance protocols. The anaesthesiologist (73.3%) decides the patient's destination, which is usually ICU (83.3%) or PACU (50%). Postoperative neurological monitoring varied according to the type of intervention, although strength and sensitivity were explored in between 70 and 80%.

Conclusions

There is great variability in the responses, probably attributable to the absence of guidelines, different structures and hospital equipment, type of surgery and qualified personnel. We need consensual protocols to standardise the treatment and the degree of monitoring needed during the postoperative period.

Keywords:
Neurosurgery
Postoperative treatment
Postoperative circuits
National survey
Resumen
Introducción

El análisis de los procesos quirúrgicos debe ser un estándar de los sistemas de salud. Describimos el circuito de atención y tratamiento postoperatorio para intervenciones neuroquirúrgicas en los centros de nuestro país.

Material y métodos

Desde junio a octubre de 2014 se difundió una encuesta a jefes de Anestesiología de 73 hospitales españoles con neurocirugía y a miembros de la Sección de Neurociencia de la SEDAR, sobre tratamientos perioperatorios y sobre los circuitos postoperatorios tras procedimientos neuroquirúrgicos.

Resultados

Obtuvimos 45 respuestas de 30 centros (41,09%). Un 60% de los anestesiólogos realiza tratamiento preventivo analgésico locorregional; la intensidad del dolor es evaluada sistemáticamente por un 78%. Las combinaciones de paracetamol, antiinflamatorios no esteroideos y morfina son las más utilizadas. Un 51,1% conoce la incidencia de NVPO tras craneotomía y el 86,7% considera necesaria la profilaxis multimodal. La dexametasona se administra como antiemético (88,9%) y/o tratamiento antiedema (68,9%). Un 44,4% de los anestesiólogos administra sistemáticamente profilaxis anticomicial en pacientes con tumores supratentoriales (levetiracetam, 88,9%). El 73,3% de los anestesiólogos disponen de protocolos de vigilancia postoperatoria. El anestesiólogo (73,3%) es quien decide el destino del paciente, que suele ser UCI (83,3%) o URPA (50%). La monitorización neurológica en el postoperatorio varió según el tipo de intervención, si bien la fuerza y la sensibilidad se exploraron en el 70-80%.

Conclusiones

Existe una gran variabilidad en las respuestas, probablemente atribuible a la ausencia de guías, diferentes estructuras y equipamiento hospitalario, tipo de cirugía y personal cualificado. Necesitamos protocolos consensuados para estandarizar el tratamiento y el grado de monitorización necesaria durante el postoperatorio.

Palabras clave:
Neurocirugía
Tratamiento postoperatorio
Circuitos de atención postoperatoria
Encuesta nacional

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