NUTRITION IN NEUROSURGERY.

DORINE AKINYI
YEAR FCS YEAR II
INTRODUCTION.

Nutrition refers to the study of how food and its components, such as carbohydrates, proteins, fats, vitamins, and
minerals, affect our health and well-being. It involves understanding the effects of different foods on our body
and how they contribute to growth, maintenance, and repair of tissues, as well as the regulation of various bodily
functions. Nutrition plays a critical role in neurosurgery, as proper nutrition is essential for optimal recovery and
healing after neurosurgical procedures. Neurosurgical nutrition is a field of study that focuses on the role of
nutrition in neurosurgical procedures and recovery. It involves understanding the specific nutritional requirements
of neurosurgical patients, as well as the impact of various dietary factors on surgical outcomes and recovery. The
goal of neurosurgical nutrition is to provide neurosurgical patients with the appropriate nutritional support they
need to optimize their health and recover from their procedure.

IMPACTS OF NUTRITION IN NEUROSURGICAL PATIENTS.

1. Supports healing in that adequate caloric and nutrient intake are necessary to support the healing
process after neurosurgery.
2. Prevents malnutrition.
3. Improves wound healing.
4. Maintains muscle mass.
5. Supports immune function.
6. Reduces inflammation.

NUTRITIONAL REQUIREMENTS

 Calories provided mainly by carbohydrate and fat

Fat=9kcal/g
Carbohydrates=4kcal/g
 Proteins=4kcal/g
 Daily caloric requirements: 30-35kcal/g
 Metabolic stress associated with sepsis, trauma, surgery or ventilation leads to increase
energy requirement(35-40kcal/kg/day)

MALNUTRITION

It is a condition that develops when the body does not get the right amount of vitamins, minerals and
other nutrients it needs to maintain healthy tissues and organ function. It can occur people who are either
undernourished or over nourished.

Under nutrition

 BMI<18kg/m2
 Weight loss>10-15% within 6months
 Serum albumin<30g/l(with no evidence of hepatic or renal dysfunction)
 80% of ideal body weight

Over nutrition

 BMI>30kg/m2
 Body weight>20% from ideal body weight

COMPLICATIONS OF MALNUTRITION
HOW GOOD NUTRITION HAS AFFECTED THE OUTCOMES IN NEUROSURGERY.

 Improves the ability to recover faster.

 Helps rebuild muscle.
 Reduces postoperative complications.
 Preoperative nutritional therapy maintains nutritional status.
 Foods rich in high protein helps in healing and repairing of tissue.

DIETARY REQUIREMENTS IN ADULTS AND CHILDREN AS PER

CARBOHYDRATES,PROTEINS,FATS,MINERALS AND VITAMINS.

Dietary requirements in both adults and children varies depending on:

 Energy requirements: Children require more energy per unit of body weight due to their rapid
growth while adults require fewer
due to their slower metabolism and low activity levels
 Protein: protein requirement in children varies with age and gender and it is needed more as
compared to adults who require fewer for maintaining muscle mass and repairing body tissue during
and after surgery
 Vitamins and minerals: they include calcium, iron vitamin D, vitamin C, and Vitamin A which are
essential in boosting the immune system and helps in cell and organ development
 Carbohydrates: carbohydrates such as whole grain, legumes and vegetables help both adults
and children in energy regeneration.
 Fats: Fats which include nuts, seeds and fish help in maintain cell function and regulating
hormone production
ASPECTS OF NUTRITION IN NEUROSURGERY.

 Energy needs.
 Protein.
 Vitamin and mineral supplementation.
 Avoiding malnutrition.

REFEEDING SYNDROME ON PATIENTS IN INTENSIVE CARE UNIT

Re-feeding syndrome is a potentially life-threatening condition that occur in neurosurgery patients who have been
malnourished or fasting for a significant period of time. The syndrome is characterized by metabolic and
electrolyte imbalance that occur when patients begin to receive nutrition after a period of malnourishment.Occurs
in patients who have undergone surgeries such as craniotomy, spinal cord injury repair, brain tumor removal etc

Symptoms of refeeding

 Electrolyte imbalance
 Fluid retention
 Respiratory distress
 Confusion
 Seizures
 Heart failure

Prevention methods

 Healthcare professionals should monitor the patient’s electrolyte levels ie potassium, magnesium
and phosphorous
 Gradually introduce nutrition
 Medication supervision
HOW TO ASSESS AND ESTIMATE ENERGY REQUIREMENTS

It is calculated by the amount of energy the body needs to perform its daily functions such as breathing,
circulating blood, and repairing cells.

Steps Used to assess and estimate energy requirements

 Determine the basal metabolic rate(BMR).

 Factor in the activity level.
 Consider the specific circumstances.

How the calculation works.

 For men:
 BEE = 293 − 3.8 × age (years) + 456.4 × height (meters) + 10.12 × weight (kg)
 For women:
 BEE = 247 − 2.67 × age (years) + 401.5 × height (meters) + 8.6 × weight (kg)

(METs − 1) × [(1.15/0.9) × Duration (minutes)]/1440)

Δ PAL =
BEE/[0.0175 × 1440 × weight (kg)]

ROLES OF NUTRITION IN NEUROSURGERY.

There have been a number of research studies focused on the role of nutrition in neurosurgery, as proper nutrition
is important for optimal recovery and healing after neurosurgical procedures. Some of the roles that nutrition
plays in neurosurgery include:

1. Enteral Nutrition.
2. Malnutrition in Neurosurgical Patients.
3. Role of Omega-3 Fatty Acids in Neurosurgical Outcomes.
4. Effects of High-Protein Diets in Neurosurgical Patients.
5. Antioxidant Supplementation.

ENTERAL NUTRTITION

 Refers to the delivery of nutrients into healthy and functioning GI tract.

 N/G tube
 Oral supplements
 Gastrostomy /jejunostomy

METHOD OF ADMINISTRATION
 PATIENTS WHO SUFFER

 Critically ill patients who are unable to eat or drink due to their condition.
 Patients who have undergone surgery and are unable to eat for a period of time.
 Patients with chronic diseases such as cancer ,HIV/AIDS among others.
 Patients with neurological disorders such as Parkinson's disease or stroke.
 Patients with eating disorders, such as anorexia nervosa.
 Patients have a standard solution which is:
 Glucose=!0%,/25%
 Fat emulsion=!0%.20%
 Amino acids solution
 PARENTERAL NUTRITION
 It refers to feeding intravenously through a vein.
 TPN:Total parenteral nutrition-involves bypassing the gastrointestinal tract. PPN: Partial
parenteral nutrition
 METHOD OF ADMINISTRATION



NUTRITION CHALLENGES THAT NEUROSURGICAL PATIENTS FACE.

Some of the nutrition challenges that neurosurgical patients face, including:

 Anorexia.
 Dysphagia.
 Malnutrition.
 Changes in metabolism.
 Immobility.

STRESS ULCERS IN NEUROSURGERY.

Stress ulcer refers to the erosion or ulceration of the stomach or duodenal lining that occur as a result of
physiological stress such as surgery, severe illness or trauma. Stress ulcers occur due to the combination of factors
such as patient’s underlying medical conditions, the physical stress of surgery, and the use of medications such as
corticosteroids and non steroidal anti-inflammatory drugs(NSAIDS).

Stress ulcers can significant morbidity and even mortality if they are not identified and treated

promptly. Some of the symptoms and effects include:

 Abdominal pain
 Nausea
 Vomiting
 Gastrointestinal bleeding.
 Infection
 Malnutrition
 Increased healthcare costs
 Delayed recovery
MANAGEMENT AND TREATMENT.

 Proactive intervention
 Treatment
 Minimizing other potential renal stressors or dialysis.
 Close monitoring and coordination among the patient’s healthcare team which include: the
surgeon, anesthesiologist and critical care specialists.
 Medications such as proton pump inhibitors(PPI) or histamine-2receptor antagonists(H2RAs) can
be prescribed.
 Diet modification
 Surgery

References

1. 1. Transforming Our World: The 2030 Agenda For Sustainable Development . Geneva: United Nations;
(2015).
Available online
at: https://sustainabledevelopment.un.org/content/documents/21252030%20Agenda%20for%20Sustainabl
e%20Development%20web.pdf (accessed March 24, 2021] Published in October 2021
2. http://guidelines.health.go.ke:8000/media/
Kenya_National_Clinical_Nutrition_and_Dietetics_Reference_Ma
nual_-_February_2010.pdf
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6422822/ 4.