Challenges in Anaesthesia During Space Exploration Missions

Benson, Stuart; Cable, Gordon G.; Workman, Lorna

doi:10.21307/asam-2019-002

Cited by 4 publications

(2 citation statements)

References 39 publications

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“…Facing these challenges, some scientists conducted clinical trials in a simulated environment, they compared the use of video-laryngoscopy in microgravity between the naïve and expertise in airway management. Results suggested that video-laryngoscopy help health care-givers to overcome these factors and it also decreases the difference in intubation efficacy between naive and expertise [21].…”

Section: Challenges In Airway Management During Space Exploration Missionsmentioning

confidence: 99%

“…Physiological accommodation to microgravity may hinder any planning of anesthesia. A previously published assumption for anesthesia airway management reported monitoring, preoxygenation, induction then bag -mask ventilation then they used Rocuronium as a muscle relaxant, followed by endotracheal tube insertion using video laryngoscopy, the tube size was smaller than the proper size to avoid edema [21].…”

Section: Anesthesia and Airway Management In Microgravitymentioning

confidence: 99%

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Airway Management in Aviation, Space, and Microgravity

Elarref¹,

Hussein²,

Khan³

et al. 2021

Special Considerations in Human Airway Management

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Although medical services in aviation have evolved over years based on our understanding of physiology, advancement in monitoring technology but airway management was only recently studied with a focus on space environment. The barometric pressure of ambient air declines as altitude increases, while the volume of air in a confined space will increase according to Boyle law, and therefore oxygen concentration remains at a constant 21%. Altitude sensitive equipment includes endotracheal and tracheostomy cuffs, pneumatic anti shock garments, air splints, colostomy bags, Foley catheters, orogastric and nasogastric tubes, ventilators, invasive monitors, and intra-aortic balloon pumps. The microgravity reduces the body compensation capacity for hemorrhage, while the redistribution of the blood can affect intubation by causing facial edema. Another change is the decreased gastric emptying during aviation. Acute respiratory failure, hypoxemia or inadequate ventilation and protection of the airway in a patient with impaired consciousness are common indications for advanced airway management in aviation. Airway management requires adequate training to maintain excellent medical care during aviation. Tracheal intubation using laryngoscopy would be difficult in microgravity, since the force exerted by the laryngoscope causes the head and neck move out of the field of vision by lever effect exerted on the head and generated through the laryngoscope blade by hand generating a lack of stability, resulting in the difficulty to insert the tracheal tube. While on the ground with the help of gravity, an adequate positioning of the patient is facilitated to achieve alignment of the laryngeal, pharyngeal and oral axes, which is known as sniffing position that allows visualization of the vocal cords and supraglottic structures allowing the introduction of an endotracheal tube.

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Section: Challenges In Airway Management During Space Exploration Missionsmentioning

confidence: 99%

Section: Anesthesia and Airway Management In Microgravitymentioning

confidence: 99%

Airway Management in Aviation, Space, and Microgravity

Elarref¹,

Hussein²,

Khan³

et al. 2021

Special Considerations in Human Airway Management

View full text Add to dashboard Cite

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Study of the pharmacokinetics of various drugs under conditions of antiorthostatic hypokinesia and the pharmacokinetics of acetaminophen under long-term spaceflight conditions

Polyakov

Svistunov

Кондратенко

et al. 2021

Drug Metabolism and Personalized Therapy

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Objectives To study the pharmacokinetics and relative bioavailability of drugs of different chemical structure and pharmacological action under conditions simulating the effects of some factors of spaceflight, as well as the peculiarities of the pharmacokinetics of acetaminophen under long-term spaceflight conditions. Methods The pharmacokinetics of verapamil (n=8), propranolol (n=8), etacizine (n=9), furosemide (n=6), and acetaminophen (n=7) in healthy volunteers after a single oral administration under normal conditions (background) and under antiorthostatic hypokinesia (ANOH), the pharmacokinetics of acetaminophen in spaceflight members under normal ground conditions (background) (n=8) and under prolonged spaceflight conditions (SF) (n=5) were studied. Results The stay of volunteers under antiorthostatic hypokinesia had different effects on the pharmacokinetics and bioavailability of drugs: Compared to background, there was a decreasing trend in Vz for verapamil (−54 Δ%), furosemide (−20 Δ%), propranolol (−8 Δ%), and acetaminophen (−9 Δ%), but a statistically significant increase in Vz was found for etacizine (+39 Δ%); there was an increasing trend in Clt for propranolol (+13 Δ%) and acetaminophen (+16 Δ%), and a decreasing trend in Clt for etacizine, verapamil, and furosemide (−22, −23 and −9 Δ% respectively) in ANOH. The relative bioavailability of etacizine, verapamil, and furosemide in ANOH increased compared to background (+40, +23 and +13 Δ%, respectively), propranolol and acetaminophen decreased (−5 and −12 Δ% accordingly). The relative rate of absorption of etacizine and furosemide in ANOH decreased (−19 and −20 Δ%, respectively) while that of verapamil, propranolol, and acetaminophen increased (+42, +58 and +26 Δ%, respectively). A statistically significant decrease in AUC0-∞ (−57 Δ%), Cmax (−53 Δ%), relative bioavailability of acetaminophen (−52 Δ%) and a sharp increase in Clt (+147 Δ%), Tmax (+131 Δ%) as well as a trend towards a significant decrease in T1/2 (−53 Δ%), MRT (−36 Δ%) and a moderate increase in Vz (+24 Δ%) were found under control compared to background. Unidirectional changes in AUC0-∞, Clt, T1/2, MRT and relative bioavailability of acetaminophen, which are more pronounced in SF and opposite dynamics for Cmax, Tmax, Vz were found in ANOH and SP compared to background studies. Conclusions The data obtained allow recommending the studied drugs for rational pharmacotherapy in the possible development of cardiovascular disease in manned spaceflight.

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Evaluation of the stability of furosemide in tablet form during six-month storage in spaceflight and peculiarities of its pharmacokinetics and pharmacodynamics under conditions of anti-orthostatic hypokinesia

Polyakov

Svistunov

Кондратенко

et al. 2022

Drug Metabolism and Personalized Therapy

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Objectives The present study investigated the stability of furosemide under space-flight conditions on board the International Space Station, as well as its pharmacokinetics and pharmacodynamics under conditions simulating exposure to some space-flight factors. Methods Quantitative analysis of furosemide tablets by HPLC was performed before spaceflight (background), then after six months storage under normal ground conditions (control) and under spaceflight conditions (SF). The pharmacokinetics and pharmacodynamics of furosemide were studied in six healthy volunteers after a single oral dose of 40 mg under normal conditions (background) and under anti-orthostatic hypokinesia (ANOH). Results Quantitative content of furosemide in tablets before SF was 40.19 ± 0.28 mg (100.47 ± 0.71%), after 6 months storage: under normal conditions (control) – 39.9 ± 0.39 mg (99.73 ± 0.98%), under SF – 39.24 ± 0.72 mg (98.11 ± 1.80%), which was within the prescribed limits. Studying basic hemodynamic parameters showed that in ANOH conditions 6 h after furosemide administration there was a statistically significant increase of the stroke volume (SV) (+36.5 Δ%), a tendency for increasing of the stroke index (SI) (+36.5 Δ%) and decreasing of the total peripheral resistance (TPR) (−21.9 Δ%) compared to baseline study. Conclusions It has been established that various factors of space flight (overloading, excessive vibration, microgravity, etc.) do not negatively influence the stability of furosemide in tablet form during storage for 6 months on board the International Space Station.

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Challenges in Anaesthesia During Space Exploration Missions

Cited by 4 publications

References 39 publications

Airway Management in Aviation, Space, and Microgravity

Airway Management in Aviation, Space, and Microgravity

Study of the pharmacokinetics of various drugs under conditions of antiorthostatic hypokinesia and the pharmacokinetics of acetaminophen under long-term spaceflight conditions

Evaluation of the stability of furosemide in tablet form during six-month storage in spaceflight and peculiarities of its pharmacokinetics and pharmacodynamics under conditions of anti-orthostatic hypokinesia

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