Blood pressure management in Aneurysmal Subarachnoid Haemorrhage prior to exclusion from circulation

Todd Fraser on 23-12-2009

This is one of those topics I can never get a handle on. What blood pressure is best for unclipped aneurysms? On the one hand, you don't want to exacerbate bleeding. On the other, you don't want to compromise cerebral perfusion in damaged areas or potentially exacerbate vasospasm. So what do you do? Try as I might, I can't get a straight answer out of anyone. A recent review by Michael Diringer in Critical Care Medicine offers the advice "hypertension requires prompt treatment" by does not define either a pressure that must be treated, nor an aim if you do. In March 2009, the American Stroke Association issued guidelines for the management of Aneurysmal SAH (available in our position statements area). They noted there were "no well controlled studies" that answer whether BP alters rebleeding rates, and make no mention of RCTs addressing the issue of BP control. They conclude : "Blood pressure should be monitored and controlled to balance the risk of stroke, hypertension related bleeding, and maintenance of cerebral perfusion pressure". Hmmmmm. So what do you do when the neurosurgeons come to beat you up?

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veerendra jagarlamudi wrote 03-09-2010 02:49:24 pm
the neuro anaesthesia book i was mentioning previously was maurice s albin , another important dilemma i always had wwhen managing blood pressure in these circumstances is whether we should aim for a MAP or an SBP

veerendra jagarlamudi wrote 01-25-2010 10:07:51 pm
there was a neuroanaesthesia textbook from the states , the name starts with A but i cant remember the author now , which says that blood pressure should be 2/3 rds of the premorbid blood pressure if it was recorded or the ward blood pressure, this is waht we used to practise as a compromise but i guess expert opinion is the best evidence when there is none

Todd Fraser wrote 02-05-2010 06:36:43 pm
I suspect you're talking about reducing blood pressure from significantly raised levels, aiming for a 25% reduction from presentation BP. However this may be too low, compromising cerebral perfusion and risking vasospasm.

Todd Fraser wrote 05-18-2010 04:44:47 pm
An interesting paper just released in the May CCM. Demonstrates a significant reduction in vasospasm in SAH patients treated with magnesium.