Fasting and nutrition in neuroanesthesia and neurocritical care patients.

Purpose of review: This review synthesizes recent evidence on nutrition management in neuroanesthesia and neurocritical care, emphasizing the role of preoperative optimization, minimizing perioperative fasting, and personalizing postoperative and intensive care nutritional support. These nutritional interventions can improve functional recovery for neurosurgical and neurocritically ill patients.

Recent findings: Malnutrition is a major risk factor for adverse outcomes in neurosurgery and neurocritically ill patients. Advancements in preoperative fasting guidelines have shifted towards more flexible approaches, such as allowing clear liquids up to 2 h before surgery and encouraging carbohydrate loading before elective surgery to improve glucose regulation and recovery. Prehabilitation strategies, including protein-rich nutrition and physical activity, improve postoperative recovery, particularly in frail patients. In the neurocritically ill, early enteral nutrition (EN) with low-to-moderate protein and calorie targets improves functional recovery and reduces complications. Recent studies challenge the necessity of prolonged fasting before extubation and ICU procedures. Despite evidence supporting reduced fasting, adherence to protocols remains low.

Summary: Advances in perioperative fasting protocols will likely improve recovery for neurosurgical patients. Early EN improves outcomes in neurocritically ill patients, while excessive calorie and protein intake may be detrimental. Addressing implementation barriers remains crucial for optimizing nutrition in neurocritical care.