Table 2.

Medical interventions for aneurysmal subarachnoid haemorrhage

Treatment	Indication or benefit	Evidencew1
Standard practice:
Nimodipine (oral) 60 mg every four hours for three weeks	Prevention—reduces risk (absolute 5%, relative 18%) of poor outcome and delayed cerebral ischaemia	Grade A,5 level 1+
≥3 litres intravenous 0.9% saline daily	Prevention—sodium depletion and hypovolaemia contribute to delayed cerebral ischaemia.29 Monitor fluid balance and cardiac function	Grade C, level 2+
Analgesia (paracetamol 1 g every six hours or dihydrocodeine 30 to 60 mg every four hours, or both	Pain relief	—
Graduated compression stockings	Prophylaxis against deep vein thrombosis	Grade B,30 level 1++
Antiemetics	As required	—
Stool softeners	As required	—
Variation in practice:
Intermittent pneumatic compression	Prophylaxis against deep vein thrombosis	Grade B,31 level 1+
Plasma volume expanders	Poor evidence for prevention or treatment of delayed cerebral ischaemia, and increases complications	Grade B,10 level 1-
Antihypertensives	No proved benefit in preventing rebleeding, and may cause cerebral ischaemiaw9	Grade B,w10 level 1-
Antifibrinolytics	No overall benefit because reduction of rebleeding is offset by more delayed cerebral ischaemia. Use before aneurysm occlusion seems more promising, but evidence is still lackingw11	Grade A,11 level 1++
Antipyretics	Temperature >37.5°C	Fever associated with poor outcomew12
Insulin sliding scale or infusion	Plasma glucose >11 mmol/l	Hyperglycaemia associated with poor outcomew3
Magnesium supplementation	Plasma magnesium <0.7 mmol/l	Hypomagnesaemia associated with poor outcomew4, w13
Antiepileptic drugs	For treatment (not prophylaxis) of seizures	—