Anesthesia and Surgery in Space: Comment

Abstract

We read the recent article penned by Komorowski et al.1 with great interest, and we congratulate the authors on a well-composed and thought-provoking article addressing space exploration and the challenges of medical care, especially anesthesia, in this austere environment.Although undersea and hyperbaric medicine is often associated with treating conditions secondary to increases in ambient pressure, such as those arising from scuba diving, it also aids in understanding and treating the pathophysiology of exposures to hypobaric conditions, like those experienced by pilots or astronauts.In fact, entering any current space suit from a living environment, such as the International Space Station or a lunar lander, requires a decompression to a lower ambient pressure.2 Human trials involving decompression from sea level (1 atmosphere absolute [ATA]) to ambient pressure of the U.S. space suit (0.3 ATA) has resulted in decompression sickness in up to 20% of exposures and venous gas emboli in up to 62%.3 Furthermore, knee pain due to decompression sickness was experienced by Gemini X astronaut Michael Collins in 1966.4Although such events in space have thus far been rare, increased numbers of human exposures and time in space will raise the probability of such an event. Thus, we believe training in undersea and hyperbaric medicine is crucial and preparatory for the future medical challenges inherent with interplanetary spaceflight. Currently, there are 10 Accreditation Council for Graduate Medical Education–approved training programs in undersea and hyperbaric medicine.5Dr. Moon reports payment for contribution to the Merck Manual (Merck and Co., Inc., Kenilworth, New Jersey). Dr. Covington declares no competing interests.