Table 1 : Reference guide: Specific recommendations for the management of vasospasm in patients with SAH.


Condition Mangement

No vasospasm  

Clinically intact --
Normal TCD --

Post clipping/coiling Normotension SBP>120 mmHg or 30% above baseline normal systemic venous pressure (8-14 cm H20)
Fluid: normal saline (NS) 200 ml/hr
Calcium channel blockers (CCB): nimodipine 60 mg po q 4hrs or 30 g/kg/h

Untreated aneurysma Normotension SBP 120-140 mmHg
  Systemic venous pressure 6-10 cm H20
  CCB as above

Subclinical vasospasm  

No DIND --
High TCDs (>200 cm/sec) --
Radio graphic evidence --
Post clipping/coiling Tripple-H Therapy
Maintain SBP 160-180 mmHg
PCWP 12-40 mmHg
Cl 5 L/min/m3
Fluid: NS + colloid 200-250 ml/h
Hct 30-35%
CCB

Untreated aneurysma Maintain SBP 120-140 mmHg
  PCWP 10-14 mmHg
  Cl 3,5-4,5 L/min/m3
  CCB

Clinical vasospasm  

DIND --
High TCDs --
Radio graphic vasospasm --

Post clipping/coiling Triple –H therapy
Increase SBP to reverse DIND
PCWP 12-16 mmHg
Refractory cases: consider angionplasty with or without intrarterial agents
CCB

Untreated aneurysma Maintain SBP 120-140 mmHg
  PCWP 12-14 mmHg
  Cl 3,5-4,5 L/min/m3
  CCB

Reference guide for the management of vasospasm in patients with SAH.
Abbreviations:
CCB: Calcium channel blockers
CI: cardiac index; DIND: delayed ischemic neurologic deficit
NS: normalsaline; PCWP: pulmonary capillary wedge pressure
SBP: systolic blood pressure; SVP: systemic venous pressure
TCD: trancranial doppler

Archavlis et al.Journal of Pharmaceutical Technology and Drug Research  2013 2:18DOI : 10.7243/2050-120X-2-18