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Subarachnoid hemorrhage (SAH) is a common and often devastating occurrence; each year approx-imately 30 000 Americans have nontraumatic SAH. 1 Despite considerable advances in diagnostic techniques, surgical, and anesthetic techniques and perioperative management, the outcome for patients with SAH remains poor, with overall mortality rates of 25% and significant morbidity among approximately 50% of survivors. 2

The evolution oftreatment protocols for patients with subarachnoid hemorrhage has been influenced consid-erably by large, multicenter prospective cohort analyses and, more recently, multicenter prospective, randomized trials. Nevertheless, several accepted treatment modalities have not been substantiated by rigorous clinical scientific assessment. In many cases specific treatments for SAH are not amenable to testing by randomized, prospective trials because of practical or ethical …