Authors: Ramaswamy, Taraa; Nagrebetsky, Alexander; Bilotta, Federico
Current Opinion in Anesthesiology 38(5):569–575, October 2025.
This review summarizes emerging evidence on nutrition management in neuroanesthesia and neurocritical care, emphasizing strategies that enhance functional recovery through improved perioperative and ICU nutrition practices.
Malnutrition remains a strong predictor of adverse outcomes in neurosurgical and neurocritically ill patients. Recent updates to fasting guidelines now support clear liquids up to two hours before surgery and preoperative carbohydrate loading to improve glucose stability and recovery. Prehabilitation measures—combining protein-rich diets and moderate exercise—show particular benefit in frail patients, improving strength and postoperative outcomes.
In the neurocritical care setting, early enteral nutrition (EN) with modest calorie and protein targets was linked to improved recovery and fewer complications. Studies also challenge the need for prolonged fasting before extubation or bedside procedures, suggesting that shortened fasting may be safe and beneficial. Despite clear evidence, adherence to these progressive nutritional protocols remains low, underscoring implementation barriers within clinical practice.
The authors conclude that tailored nutrition strategies—ranging from preoperative optimization to individualized ICU feeding—are essential to enhance outcomes and minimize complications in neurosurgical patients.
What You Should Know
• Flexible fasting protocols and preoperative carbohydrate loading improve surgical recovery and metabolic control.
• Early, moderate enteral nutrition benefits neurocritically ill patients and lowers complication rates.
• Overfeeding, particularly excessive protein or calorie intake, can be harmful.
• Clinical adherence to evidence-based nutrition practices remains suboptimal, requiring systems-level solutions.
Thank you to Current Opinion in Anesthesiology for allowing us to review this important update on perioperative and neurocritical nutrition management.