How should blood pressure be managed following subarachnoid haemorrhage when there is an unsecured aneurysm?

Unsecured Aneurysm
(Before clipping /coiling)
  • Systolic pressure should be maintained <180-160 mmHg 1 (ESO / AHA guidance) to reduce risk of rebleeding
    • May be achieved with nimodipine and analgesia
    • If required a titratable agent should be used (e.g. labetalol, nitrates, hydralazine)
    • Labetalol 5-10mg bolus and infusion may be first line
  • MAP >90 mmHg should be targeted 1 to maintain cerebral perfusion
    • Secured Aneurysm
    (After clipping /coiling)
    • Targets are individualised to the patient depending upon the clinical picture
    • Hypertension does generally not require treatment unless concomitant cardiac myocardial ischaemia / dysfunction
    • MAP >90 mmHg should be targeted to maintain cerebral perfusion
    • Higher MAP targets (induced hypertension) may be required in the setting of cerebral ischaemia
    ESO Guidelines

    G

    AHA Guidelines

    G