Anaesthetists and aerospace medicine in a new era of human spaceflight

Smith, Thomas G.; Buckey, Jay C.

doi:10.1111/anae.15580

Cited by 5 publications

(6 citation statements)

References 22 publications

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“…This is changing with the advent of commercial suborbital spaceflight for paying customers, who experience several minutes of μG between high G loads that may exceed 3 Gx for 20 ‐ 30 s and peak at ≤ 6 Gx on re‐entry (Blue Origin, 2018; Blue et al., 2014; Stepanek et al., 2019). These flights are targeted at tourists and scientific researchers but are ultimately expected to develop into extremely fast point‐to‐point travel (T. G. Smith & Buckey, 2021). Parallels have been drawn between the emerging suborbital spaceflight industry and the early days of air travel a century ago, which began as joyrides for those who could afford them and eventually transformed global transportation.…”

Section: +Gx: Suborbital/orbital Spaceflight Launch and Re‐entrymentioning

confidence: 99%

“…G. Smith & Buckey, 2021;Suresh et al, 2017). Detailed physiological studies in relevant passenger groups are required to support the development of an evidence-based medical approach that ultimately minimizes morbidity while maximizing access to suborbital flights (T. G. Smith & Buckey, 2021;Stepanek et al, 2019).…”

Section: Commercial Suborbital Spaceflightmentioning

confidence: 99%

“…In summary, suborbital high G peaks are brief, and it is likely that most people will be able to tolerate flights safely. Underlying physiological responses to +Gx will nevertheless be triggered to some extent and might become clinically meaningful in some medically susceptible passengers (Pollock, Jolley, et al., 2021; T. G. Smith & Buckey, 2021; Suresh et al., 2017). Detailed physiological studies in relevant passenger groups are required to support the development of an evidence‐based medical approach that ultimately minimizes morbidity while maximizing access to suborbital flights (T. G. Smith & Buckey, 2021; Stepanek et al., 2019).…”

Section: +Gx: Suborbital/orbital Spaceflight Launch and Re‐entrymentioning

confidence: 99%

Section: Commercial Suborbital Spaceflightmentioning

confidence: 99%

“…Doctors are familiar with the concept of determining fitness to fly in airline passengers and, more broadly, in assessing and then optimizing the capacity of a patient to withstand major surgery. Suborbital spaceflight likewise presents a significant physiological challenge for some prospective passengers, and similar principles of evaluation and risk modification can be applied (T. G. Smith & Buckey, 2021). Undertaking a preflight ‘G challenge test’ on a centrifuge might be beneficial in this regard and warrants investigation (Pollock, Jolley, et al., 2021).…”

Section: +Gx: Suborbital/orbital Spaceflight Launch and Re‐entrymentioning

confidence: 99%

See 4 more Smart Citations

Oh G: The x, y and z of human physiological responses to acceleration

Pollock

Hodkinson

Smith

2021

Experimental Physiology

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New Findings What is the topic of this review?This review focuses on the main physiological challenges associated with exposure to acceleration in the Gx, Gy and Gz directions and to microgravity. What advances does it highlight?Our current understanding of the physiology of these environments and latest strategies to protect against them are discussed in light of the limited knowledge we have in some of these areas. Abstract The desire to go higher, faster and further has taken us to environments where the accelerations placed on our bodies far exceed or are much lower than that attributable to Earth's gravity. While on the ground, racing drivers of the fastest cars are exposed to high degrees of lateral acceleration (Gy) during cornering. In the air, while within the confines of the lower reaches of Earth's atmosphere, fast jet pilots are routinely exposed to high levels of acceleration in the head–foot direction (Gz). During launch and re‐entry of suborbital and orbital spacecraft, astronauts and spaceflight participants are exposed to high levels of chest–back acceleration (Gx), whereas once in space the effects of gravity are all but removed (termed microgravity, μG). Each of these environments has profound effects on the homeostatic mechanisms within the body and can have a serious impact, not only for those with underlying pathology but also for healthy individuals. This review provides an overview of the main challenges associated with these environments and our current understanding of the physiological and pathophysiological adaptations to them. Where relevant, protection strategies are discussed, with the implications of our future exposure to these environments also being considered.

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Section: +Gx: Suborbital/orbital Spaceflight Launch and Re‐entrymentioning

confidence: 99%

Section: Commercial Suborbital Spaceflightmentioning

confidence: 99%

Section: +Gx: Suborbital/orbital Spaceflight Launch and Re‐entrymentioning

confidence: 99%

Section: Commercial Suborbital Spaceflightmentioning

confidence: 99%

Section: +Gx: Suborbital/orbital Spaceflight Launch and Re‐entrymentioning

confidence: 99%

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Oh G: The x, y and z of human physiological responses to acceleration

Pollock

Hodkinson

Smith

2021

Experimental Physiology

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Gene-environmental influence of space and microgravity on red blood cells with sickle cell disease

Igbineweka,

van Loon

2024

npj Genom. Med.

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A fundamental question in human biology and for hematological disease is how do complex gene-environment interactions lead to individual disease outcome? This is no less the case for sickle cell disease (SCD), a monogenic disorder of Mendelian inheritance, both clinical course, severity, and treatment response, is variable amongst affected individuals. New insight and discovery often lie between the intersection of seemingly disparate disciplines. Recently, opportunities for space medicine have flourished and have offered a new paradigm for study. Two recent Nature papers have shown that hemolysis and oxidative stress play key mechanistic roles in erythrocyte pathogenesis during spaceflight. This paper reviews existing genetic and environmental modifiers of the sickle cell disease phenotype. It reviews evidence for erythrocyte pathology in microgravity environments and demonstrates why this may be relevant for the unique gene-environment interaction of the SCD phenotype. It also introduces the hematology and scientific community to methodological tools for evaluation in space and microgravity research. The increasing understanding of space biology may yield insight into gene-environment influences and new treatment paradigms in SCD and other hematological disease phenotypes.

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Evaluation of free-floating tracheal intubation in weightlessness via ice-pick position with a direct laryngoscopy and classic approach with indirect videolaryngoscopy

Thierry,

Jaulin,

Starck

et al. 2023

npj Microgravity

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Long duration spaceflights to the Moon or Mars are at risk for emergency medical events. Managing a hypoxemic distress and performing an advanced airway procedure such as oro-tracheal intubation may be complicated under weightlessness due to ergonomic constraints. An emergency free-floating intubation would be dangerous because of high failure rates due to stabilization issues that prohibits its implementation in a space environment. Nevertheless, we hypothesized that two configurations could lead to a high first-pass success score for intubation performed by a free-floating operator. In a non-randomized, controlled, cross-over simulation study during a parabolic flight campaign, we evaluated and compared the intubation performance of free-floating trained operators, using either a conventional direct laryngoscope in an ice-pick position or an indirect laryngoscopy with a video-laryngoscope in a classic position at the head of a high-fidelity simulation manikin, in weightlessness and in normogravity. Neither of the two tested conditions reached the minimal terrestrial ILCOR recommendations (95% first-pass success) and therefore could not be recommended for general implementation under weightlessness conditions. Free-floating video laryngoscopy at the head of the manikin had a significant better success score than conventional direct laryngoscopy in an ice-pick position. Our results, combined with the preexisting literature, emphasis the difficulties of performing oro-tracheal intubation, even for experts using modern airway devices, under postural instability in weightlessness. ClinicalTrials registration number NCT05303948.

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Anaesthetists and aerospace medicine in a new era of human spaceflight

Cited by 5 publications

References 22 publications

Oh G: The x, y and z of human physiological responses to acceleration

Oh G: The x, y and z of human physiological responses to acceleration

Gene-environmental influence of space and microgravity on red blood cells with sickle cell disease

Evaluation of free-floating tracheal intubation in weightlessness via ice-pick position with a direct laryngoscopy and classic approach with indirect videolaryngoscopy

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