Medical and Sporting Ethics of High Altitude Mountaineering: The Use of Drugs and Supplemental Oxygen

Wagner, Dale R.

doi:10.1016/j.wem.2012.03.011

Cited by 3 publications

(4 citation statements)

References 8 publications

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“…To the Editor: We enjoyed George Rodway's Wilderness Essay, 1 which was intriguingly entitled "Decision making at extreme altitude: has anyone seen my executive function recently?" Obvious and potentially illuminating parallels can be drawn with cerebral function in patients undergoing locoregional carotid endarterectomy (CEA).…”

Section: Has Anyone Seen My Executive Function Recently?mentioning

confidence: 99%

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“Performance Enhancing” Drugs at High Altitude

Zafren¹,

Berghold²,

Hillebrandt³

2013

Wilderness & Environmental Medicine

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Section: Has Anyone Seen My Executive Function Recently?mentioning

confidence: 99%

“…We read with interest the editorial: “Medical and sporting ethics of high altitude mountaineering” 1 and the thoughtful comments of the invited discussants. 2 We would like to clear up what we believe are a few misconceptions.…”

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confidence: 99%

“Performance Enhancing” Drugs at High Altitude

Zafren¹,

Berghold²,

Hillebrandt³

2013

Wilderness & Environmental Medicine

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“…Although the most effective strategy is a gradual ascent rate, 3,4 an increasing number of climbers and trekkers are using pharmaceuticals. 5 The role of prophylactic medication in this setting has been described in a number of guidelines, and although ethical debate remains 6,7 the position of acetazolamide as the first-line agent is clearly defined. [8][9][10] As such, with the exception of a few uncommon circumstances such as intolerance or allergy, acetazolamide is the drug of choice for those who decide to use medication to reduce the risk of developing acute mountain sickness (AMS).…”

Section: Introductionmentioning

confidence: 99%

“…13 High-altitude mountaineering is a high-risk activity 14 that has a longstanding relationship with prophylactic medications and performance-enhancing drugs. 6 Climbers are often at the extremes of their physiologic reserve, and the gains from medications can be significant. Trekking, on the other hand, is a far less dangerous activity.…”

Section: Introductionmentioning

confidence: 99%

Inappropriate Dexamethasone Use by a Trekker in Nepal: A Case Report

Haslam

Garth

Kelly

2017

Wilderness & Environmental Medicine

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We present a case of inappropriate dexamethasone use in a trekker in the Everest region of Nepal. We aim to increase awareness among health professionals of the possible use of this medication by trekkers and promote knowledge of potential complications. In this case, a previously altitude-naive trekker was prescribed prophylactic dexamethasone by physicians in a Western travel clinic before high-altitude trekking in Nepal. There were no indications for prophylactic medication nor for the use of dexamethasone. The trekker reported that no discussion regarding risks and benefits, alternatives, side effects, contraindications, or dose tapering on completion of the course had occurred before travel. Side effects were temporary, but serious complications may have ensued if it not for timely interventions by doctors at the International Porter Protection Group rescue post. The events leading to inappropriate dexamethasone use in this case cannot be known for certain. However, it is clear that the trekker lacked the knowledge to use the medication safely. Although the efficacy of dexamethasone in the prevention of acute mountain sickness is undisputed, associated side effects and other limitations make acetazolamide the prophylactic drug of choice. Inappropriate use of dexamethasone can lead to severe complications, and such a case has been reported from Mount Everest. Clinicians prescribing dexamethasone must understand the indications and risks, and health professionals at altitude should be aware of its use by trekkers and the potential complications.

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Medication Use Among Mount Everest Climbers: Practice and Attitudes

Luks

Grissom

Freer

et al. 2016

High Altitude Medicine & Biology

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Luks, Andrew M., Colin Grissom, Luanne Freer, and Peter Hackett. Medication use among mount Everest climbers: practice and attitudes. High Alt Med Biol. 17:315-322, 2016.-The lay public, media, and medical experts have expressed concern about the ethics of climbers using medications to improve performance and increase the odds of summit success while climbing at high altitude, but the true incidence of this practice remains unclear. We conducted an anonymous survey of climbers who have attempted to climb Mt. Everest to gather information about medication use and attitudes toward medication and supplemental oxygen use while climbing the mountain. One hundred eighty-seven individuals completed the survey, providing information about medication and oxygen use for 262 expeditions to Mt. Everest between 1963 and 2015, the majority of which occurred after the year 2000. The majority of respondents were male (82%) and from English-speaking countries (75%). Medications were used on 43% of climbs, with acetazolamide being the most commonly used medication. Reported use of dexamethasone, nifedipine, sildenafil, or tadalafil was uncommon as was use of multiple medications at the same time. The majority of respondents indicated that it was acceptable for climbers to use medications and supplemental oxygen to prevent altitude illness while climbing Mt. Everest. Opinions were more mixed regarding whether summiting without the use of medications or oxygen carried the same value as reaching the summit using those interventions. Our data suggest that less than one-half of Mt. Everest climbers use medications during their expedition, with the primary medication used being acetazolamide, for prevention of altitude illness. Given the limitations of the study design and preliminary nature of these data, further research is warranted to further clarify these issues.

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Medical and Sporting Ethics of High Altitude Mountaineering: The Use of Drugs and Supplemental Oxygen

Cited by 3 publications

References 8 publications

“Performance Enhancing” Drugs at High Altitude

“Performance Enhancing” Drugs at High Altitude

Inappropriate Dexamethasone Use by a Trekker in Nepal: A Case Report

Medication Use Among Mount Everest Climbers: Practice and Attitudes

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