Statement by which to determine a course of action. A guideline aims to streamline particular processes according to a set routine or sound practice. By definition, following a guideline is never mandatory.

Guidelines are not binding and are not enforced. Protocols are often considered to be stricter than a guideline, and to carry more weight with the law, but there is no hard evidence to support this view and the terms are usually used interchangeably.

Guidelines may be issued by and used by any organization (governmental or private) to make the actions of its employees or divisions more predictable, and presumably of higher quality.

see Grade

The analysis of surgical processes should be a standard of health systems.

Valero et al., describe the circuit of care and postoperative treatment for neurosurgical interventions in the centres of Spain.

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.

They 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 70-80%.

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 standardize the treatment and the degree of monitoring needed during the postoperative period 1).

Major pharmaceutical companies selling antihypertensive drug products in the Japanese market had a significant financial connection with the JSH2019 authors. Financial relationships between pharmaceutical companies and authors or Japanese medical societies are raising significant concerns about the credibility of clinical guidelines and the potentially biases and undue influences that they may cause, especially with respect to adverse prescription patterns 2).

Valero R, Carrero E, Fàbregas N, Iturri F, Saiz-Sapena N, Valencia L; Sección de Neurociencia de la Sociedad Española de Anestesiología y Reanimación.. National survey on postoperative care and treatment circuits in neurosurgery. Rev Esp Anestesiol Reanim. 2017 Mar 16. pii: S0034-9356(17)30027-0. doi: 10.1016/j.redar.2017.01.003. [Epub ahead of print] English, Spanish. PubMed PMID: 28318531.
Senoo Y, Saito H, Ozaki A, Sawano T, Shimada Y, Yamamoto K, Suzuki Y, Tanimoto T. Pharmaceutical company payments to authors of the Japanese guidelines for the management of hypertension. Medicine (Baltimore). 2021 Mar 26;100(12):e24816. doi: 10.1097/MD.0000000000024816. PMID: 33761642.
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