Sundal Einar Vie, Giil Lasse Melvær
Tidsskr Nor Laegeforen. 2020 Jan 20;140(2). doi: 10.4045/tidsskr.19.0558. Print 2020 Feb 4.
The management of benzodiazepine-resistant GHB withdrawal requires careful consideration of GHB pharmacodynamics.
A young woman was admitted with tachycardia, confusion, agitation and delusions the day after attempting to quit a daily, high-dose GHB habit. A total of 225 mg of diazepam had no effect. She was sedated with propofol and intubated. An extubation attempt after 24 hours was followed by recurrence of delirium. After reintubation she required high doses of propofol, alfentanil and dexmedetomidine to maintain sedation for two days. Baclofen and diazepam were introduced on the third day, allowing dose reductions in anaesthetic agents the fourth day and extubation on the fifth day with resolution of the delirium.
GHB targets the GABAB receptor and downregulates it with abuse. Most anaesthetic agents affect the GABAA receptor. Our report suggests that baclofen, a GABAB receptor agonist, may reduce the need for anaesthetic agents and facilitate recovery.
苯二氮卓类药物抵抗性γ-羟基丁酸（GHB）戒断的管理需要仔细考虑GHB的药效学。
一名年轻女性在试图戒除每日高剂量GHB习惯后的第二天，因心动过速、意识模糊、躁动和妄想入院。总共225毫克地西泮无效。她接受丙泊酚镇静并插管。24小时后尝试拔管，随后谵妄复发。再次插管后，她需要高剂量的丙泊酚、阿芬太尼和右美托咪定来维持两天的镇静。第三天使用巴氯芬和地西泮，第四天可减少麻醉剂剂量，第五天拔管，谵妄消退。
GHB作用于GABAB受体并因滥用而下调该受体。大多数麻醉剂作用于GABAA受体。我们的报告表明，GABAB受体激动剂巴氯芬可能减少对麻醉剂的需求并促进恢复。
