Volume 181 - Issue 6
Epidemic of γ-hydroxybutyrate (GHB) ingestion
Author: T C K Brown
Med J Aust 2004; 181 (6): 343. || doi: 10.5694/j.1326-5377.2004.tb06314.x
Published online: 20 September 2004
Published online: 20 September 2004
T C K Brown
Former Director of Anaesthesia, Royal Children's Hospital, Flemington Road, Parkville, VIC 3052. tckbrownATnetspace.net.au
To the Editor: The epidemic of recreational use of γ-hydroxybutyrate (GHB; also known as γ-OH) is a cause for concern, as it is a basal anaesthetic agent (ie, it renders the patient unconscious, with analgesic supplementation required for surgery). It is not surprising that people taking too much of it are becoming unconscious.1
GHB was introduced in France as a basal anaesthetic agent by Laborit about 1960. It has a slow onset of action (up to 10 minutes when given intravenously, thought to be due to conversion to an active metabolite, γ-butyrolactone).2 It causes bradycardia, sometimes requiring atropine administration to maintain cardiac output, and raises blood pressure. Respiration is slow and deep, so that alveolar ventilation is not reduced.
Trials of GHB as an anaesthetic were conducted in Melbourne by Dr William Cole and myself in the late 1960s,3-5 and it was used for microlaryngeal surgery for several years. Its major problems were prolonged sleep (1–3 hours after 40–100 mg/kg in children) and a high incidence of postoperative vomiting, adding the danger of aspiration in unconscious patients.
GHB was also tried as an anaesthetic in Dunedin, New Zealand, where it was found that the sleep time could be reduced by intravenous administration of physostigmine.6
The fact that this drug is a basal anaesthetic needs to be more widely publicised.
References
- Five in hospital after party drug overdose. The Age 2004; 23 May. Available at: www.theage.com.au/articles/2004/05/23/1085250859718.html?oneclick=true (accessed Jul 2004).
- Bessman SP, Skolnik JJ. Gamma hydroxybutyrate and gamma butyrolactone: concentration in rat tissues during anaesthesia. Science 1964; 143: 1045-1047. CBBCFCCA
- Brown TCK. Gammahydroxybutyrate in paediatric anaesthesia. ANZ J Surg 1970; 40: 94. i1085573
- Cole WHJ. Observations on the pharmacology of gamma hydroxy sodium butyrate, with special reference to microsurgery of the larynx. Med J Aust 1970; 1: 372.
- Thompson JR, Greer CH, Cole W. Surgical microscopy of the larynx. (Microsurgery of the larynx, microlaryngology, microlaryngoscopy). (Endolaryngeal microsurgery). Laryngoscope 1971; 81: 772-783. CBBDFIBI
- Henderson RS, Holmes CM. Reversal of the anaesthetic action of sodium gamma-hydroxybutyrate. Anaesth Intensive Care 1976; 4: 351-354. CBBHFFAD