Acta neurochirurgica. Supplement
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Currently there are no published standards of neuroanesthesia. However, consensus guidelines based on physiological considerations, published literature, clinical experience and expert opinions do exist. Four areas of the practice of neuroanesthesia: premedication, intraoperative algorithms, emergency algorithms, and postoperative care of the neurosurgical patient will be reviewed.
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Written specifications with regard to procedures performed, equipment used, and training of the involved personnel are widely used in the industry and aviation to guarantee constant quality. Similar systems are progressively being introduced to medicine. ⋯ Written standards and checklists are also a useful training tool within a university hospital and facilitate communication of essentials to the residents. Comparison with aviation suggests that standardization leads to a remarkable but nonetheless limited reduction of adverse incidents.
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At present, quality assurance in United States neurosurgery is based primarily on neurosurgeons meeting requirements for certification by the American Board of Neurological Surgery and residency training programs meeting requirements for approval by the neurosurgical Residency Review Committee. These organizations, plus a number of other private, autonomous, physician directed groups have assumed responsibility for assuring neurosurgical quality. ⋯ A more detailed review of the process of neurosurgical credentialing is also presented and a paradigm for evaluating and improving neurosurgical quality is proposed. It must be clearly stated that the opinions expressed in this article are those of the author and do not represent the official position of any neurosurgical organization.