Anaesthesia in austere environments: literature review and considerations for future space exploration missions

Abstract

Future space exploration missions will take humans far beyond low Earth orbit and require complete crew autonomy. The ability to provide anaesthesia will be important given the expected risk of severe medical events requiring surgery. Knowledge and experience of such procedures during space missions is currently extremely limited. Austere and isolated environments (such as polar bases or submarines) have been used extensively as test beds for spaceflight to probe hazards, train crews, develop clinical protocols and countermeasures for prospective space missions. We have conducted a literature review on anaesthesia in austere environments relevant to distant space missions. In each setting, we assessed how the problems related to the provision of anaesthesia (e.g., medical kit and skills) are dealt with or prepared for. We analysed how these factors could be applied to the unique environment of a space exploration mission. The delivery of anaesthesia will be complicated by many factors including space-induced physiological changes and limitations in skills and equipment. The basic principles of a safe anaesthesia in an austere environment (appropriate training, presence of minimal safety and monitoring equipment, etc.) can be extended to the context of a space exploration mission. Skills redundancy is an important safety factor, and basic competency in anaesthesia should be part of the skillset of several crewmembers. The literature suggests that safe and effective anaesthesia could be achieved by a physician during future space exploration missions. In a life-or-limb situation, non-physicians may be able to conduct anaesthetic procedures, including simplified general anaesthesia.

Airway management in microgravity: A systematic review

“…Silverman and McCartney support the use of regional anesthesia, but indications are mostly limited to limb injuries, training requirements are high and the failure rate ought not to be underestimated in practice. Specific sedation and GA protocols have been suggested for spaceflight . A pilot study suggested that unassisted personnel with minimal medical training may be able to perform a GA with intubation during a Mars mission …”

“…ISS testing of these concepts would be desirable, but challenging to achieve in light of transportation costs to low Earth orbit. Furthermore, the medical problems during ISS presence as well as on the Mars are of utmost importance and require future research activities . Both the laws of physics and its impact on how to perform anesthesia and surgery must be theoretically planned and tested practically to build up a feasible and safe concept for long‐duration space missions.…”

“…A growth in the space tourism sector as well as a shift toward long‐duration interplanetary missions to the Moon and Mars have been predicted in the near future . These missions will unavoidably be associated with an increased risk of acute medical problems, which will need to be handled by an autonomous crew operating in extreme isolation . Space tourists may be at increased risk of medical problems, when compared to the conventional astronaut corps .…”

“…Because evacuation will most likely not be possible during space exploration missions, there will be an increased need for emergency care skills and for the continuous training of crew members . In addition, communication delays of up to 20 minutes in each direction between the Earth and Mars will preclude real‐time tele‐medical support.…”

“…An important skill in numerous medical emergencies is represented by airway management. Schematically, it is indicated for respiratory failure, airway obstruction or coma and is a key component of GA . Between 1961 and 1999, there were 17 severe medical events during spaceflight including chemical pneumonitis, aspiration, and smoke inhalation, but fortunately none of which required intubation .…”