ReviewJournal of anesthesia, analgesia and critical care2026
Perioperative anemia and patient blood management in neurosurgery and neurocritical care: a narrative review.
Review in Journal of anesthesia, analgesia and critical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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10 authors.
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Abstract
Correction of anemia in the perioperative period is essential to reduce complications, optimise tissue oxygen delivery and improve overall patient outcomes. However, in neurosurgical and neurocritical care settings, the management of preoperative anemia presents unique challenges. The brain is highly sensitive to reductions in oxygen delivery, whereas interventions commonly used to correct anemia, most notably blood transfusions, carry inherent risks that may adversely affect neurological outcomes. Therefore, clinicians must carefully balance the prevention of cerebral hypoxia to avoid treatment-related complications.The prevalence of perioperative anemia in neurosurgical and neurocritical patients is influenced by multiple factors, including advanced age, comorbidities, frailty, malnutrition, chronic anticoagulant or antiplatelet therapy and the type and extent of planned intervention.Patient blood management provides a structured, multimodal approach for optimising oxygen delivery, while reducing exposure to allogeneic blood transfusion. Within this framework, anemia correction represents only one pillar, alongside strategies to minimise perioperative blood loss and enhance physiological tolerance to anemia. In neurosurgical and neurocritical care, patient blood management may include targeted anemia treatment (e.g. iron supplementation, erythropoiesis-stimulating agents or carefully restricted transfusion), management of coagulation disturbances using specific "antidotes" such as tranexamic acid and close monitoring of cerebral oxygenation to individualize transfusion and hemodynamic decisions.Despite the limited standardization of patient blood management pathways in neurosurgery, current evidence suggests that it represents a coherent and physiologically grounded approach that may contribute to improved outcomes in this high-risk patient population.
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