Airway and breathing

Following gamma-hydroxybutyrate (GHB) poisoning, close observation in a critical care area is essential to ensure an adequate airway in all patients with central nervous system (CNS) depression. The patient can often be managed conservatively, with supportive care in the left lateral position, providing this maintains an adequate airway.

If the patient’s airway is compromised, they are vomiting or hypoventilating, intubate and ventilate the patient. As recovery from GHB poisoning is generally rapid, intubation and ventilation may not be required for patients in a coma with an adequate airway. Consider intubation and ventilation for patients who have been in a coma for more than 4 hours. If the patient is intubated, monitor the patient closely until they wake, as there is a risk of self-extubation upon waking.