- The calcium channel blocking drug nimodipine
(Nimotop) is routinely given for 21 days
after SAH to prevent vasospasms and to enhance collateral
- Anticonvulsants are given as prophylaxis
- Stool softeners prevent constipation and
straining at stool, which results in the patient
performing a Valsalva maneuver. The Valsalva maneuver
increases intracranial pressure and blood pressure, two
factors that are associated with aneurysmal rebleeding.
- The use of steroids is controversial.
However, some clinicians believe that steroids are
beneficial for treatment of cerebral edema and the
inflammatory effect of meningeal irritation.
- Analgesics such as acetaminophen or
codeine are given to control headache.
- Sedatives such as phenobarbital may be
given to the agitated patient at risk for elevated blood
- The osmotic diuretic mannitol
may be given to decrease cerebral edema, improve cerebral
blood flow, and decrease neurological deficits. A
decrease in cerebral edema lowers both ICP and systemic
- Volume expansion can
improve perfusion during vasospasm. Hypotension should be avoided, as
it can cause decreased cerebral perfusion.
- If the patient is
hypertensive, antihypertensive drugs may be given to prevent
rebleeding. A therapeutic goal systolic
pressure is approximately l30 mm. Hg.