How do you manage vasospasm and delayed cerebral ischaemia?

Induced Hypertension

• Improves CBF (possibly more in areas of vasospasm) with associated clinical improvement
• Noradrenaline safe and usually first line - no risk of increased vasospasm
• No evidence of new rupture risk
• No clear BP target or duration:
  • Evidence limited
  • Used on clinical grounds assessing response to therapy or reductions
• Limited value when infarct established

Euvolaemia

• Optimises cerebral blood flow
• Cardiac output monitoring may be useful to guide fluid therapy
• Hypervolaemia associated with increased complications