The Cosmic Operating Room

For many, the notion of surgery in space is unfathomable.

But as travel into the relatively unknown increases, so too does the chance of serious injury. Where a broken arm on earth might mean some discomfort and a trip to the emergency room, a broken arm in space would not only mean suffering for an untreated astronaut but could also compromise the mission and safety of other team members.

In the event of serious injury, astronauts would ideally be returned to earth for treatment. Systemic pain medications could impair cognition and even decrease the drive to breath. Returning to earth from the International Space Station could be accomplished in hours, but extraction from the moon could take days, and from Mars – months. In the case of distant space exploration, damage control procedures may be necessary. However, the administration of general anesthesia is limited by many technical and physiological challenges of outer space.

Dr. Jon Bailey, a Nova Scotia Health regional anesthesia specialist and assistant professor in the Department of Anesthesia, Pain Management and Perioperative Medicine at Dalhousie University, has set out to make surgery and pain management in space a reality.

Underwater simulation

Treating injuries in space comes with many challenges, including altered physiology, swelling in the throat's air passages, and a very poor intubation rate in experimental models. Regional anesthesia has been suggested as a solution for pain management, or even to allow surgical procedures, in a microgravity environment, but the feasibility of performing the procedure in microgravity has yet to be tested. Although the first anesthetic-assisted surgery on rodents occurred in 1990, no human has ever undergone surgery in space.

Together with his team, anesthesiologist colleagues Drs. Mathew Kiberd, Regan Brownbridge, Garrett Barry, Matthew Mackin, Dan Werry, and Sally Bird, Dr. Bailey is evaluating the viability of using ultrasound-guided perineural injections to administer regional anesthesia, a technique used to numb a specific part of the body, in a simulated microgravity environment. In this case—underwater.

Some members of Dr. Bailey’s team (from left to right): Drs. Matthew Mackin, Mathew Kiberd, Jon Bailey, Regan Brownbridge.

The Canadian Space Agency has utilized deep water for space exploration simulations for years, but no studies have been conducted in this setting to evaluate regional anesthesia.

Several members of Dr. Bailey’s team are certified scuba divers, an obvious asset for this project, which requires significant time underwater.

 “The team came together fairly organically after I contacted the individuals who I thought would be a good fit,” recalls Dr. Bailey. “This is also a rare instance of a project where the majority of the people I spoke with were genuinely enthusiastic and wanted to participate.”

The team conducted two studies. In the first, they tested how well a dye works in meat models simulating nerves. They injected 30 meat models and scored for the ease of interpretation and accuracy. In the second study, the team used 40 meat models to evaluate the administration of regional anesthesia in two conditions: microgravity analogue and normal earth gravity. They injected dye into the models using ultrasound and then evaluated for success with two accessors after 24 hours. Results in the first study showed the meat model worked well, with assessors correctly identifying dye positions most of the time. In the second study, they found that giving anesthesia in space is possible, but placing needles is trickier in microgravity compared to normal gravity.

One of the meat models, encased with ballistic gel to avoid contact and to improve durability.

This work has the potential to pave the way for the development of medical techniques that will ensure the safety of astronauts and the success of space missions.

“Nerve blocks are very likely the safest way to provide pain control for an astronaut with an injury,” says Dr. Bailey. “The techniques to maximize effectiveness and safety haven’t yet been developed in microgravity.”

Outsized impact

Dr. Bailey’s research is the inaugural recipient of the Orlando Hung Innovation Fund (OHIF) Award, named in honour of Dr. Orlando Hung, a celebrated professor in the Department of Anesthesia, Pain Management & Perioperative Medicine, and dedicated to supporting early ideas that can develop best practice models and procedures.

"Having the award named after me is a tremendous honour, and I am truly grateful,” says Dr Hung. “It is my hope that this award will contribute to the development of early studies of clinical, educational, research, or administrative innovations with the aspiration of how we can always do better.”

Part of the Department of Anesthesia’s Anesthesia Research Fund Awards, the OHIF aims to facilitate systemic change and remove barriers that may hinder the timely development, assessment, and implementation of medical innovations that improve patient lives.

“Dr. Hung has been an inspiring clinician, researcher, and humanitarian and I’m very grateful that our department has such strong support for research and innovation,” says Dr. Bailey. “This has allowed us to have an outsized impact nationally.”

Dr. Bailey plans to engage in a collaborative effort with the Health Beyond Initiative of the Canadian Space Agency in order to advance and expand the research on the administration of regional anesthesia in microgravity settings. Enthusiastically looking ahead, he aims to further explore the model established in this project by involving personnel without anesthesia expertise, potentially revolutionizing healthcare delivery in remote and extreme locations, including military and rescue operations.

Dr. Bailey envisions a future where logistical considerations lead to the creation of a specialized regional anesthesia kit tailored for use on the International Space Station, marking another milestone in advancing medical practices beyond the confines of Earth.