title: The feasibility of pharmacological mitigation of nitrogen narcosis during submarine escapes from depths down to 1,000 fsw.
abstract: BACKGROUND
  Nitrogen (N2) narcosis could interfere with deep submarine escapes, particularly in the escape trunk, where simple but essential tasks are required in order to leave the submarine and start rapid ascent. In a previous study, we had suggested that prolongation of lungs-to-brain circulation time (LBct) may have a protective effect on N2 narcosis, a hypothesis tested in the present study.
  
  
  METHODS
  Computer software was designed to assess the effects of changes in circulation times on N2 uptake and distribution during the extremely rapid pressure changes typical of submarine escapes. Simulations of escapes from 600 to 1,000 fsw (with 200-fsw steps) were performed, with varying dwell times (DT) in the escape trunk (from 10 to 60 seconds, in 10-second steps). Baseline cardiac output (CO) was set at 5 liters/minute, and it was varied through changes in heart rate from 50% to 200% in the escape simulations. LBct was assumed to vary inversely with CO.
  
  
  RESULTS
  The risk of N2 narcosis was expressed as equivalent narcosis depth (END) in fsw, corresponding to N2 pressure in the brain after five minutes of air diving at that equivalent depth. The effects of changing CO on the highest END values (corresponding to the peak N2 pressures) reached while in the escape trunk or during entire escapes were tabulated. Depths at which peak N2 occurred were also analyzed. Prolonging LBct appeared to have two advantageous effects: 1. It reduced peak N2 reached both in the escape trunk and during the entire course of the escape 2. It delayed peak N2 to later stages of escapes (i.e., closer to the surface during ascent). These effects were more evident at greater escape depths and with longer DTs.
  
  
  CONCLUSIONS
  Prolongation of LBct could protect against N2 narcosis and it could plausibly be achieved with the oral administration of a beta-blocker, such as propranolol, prior to deep submarine escape. Animal experiments should be conducted to validate this pharmacological approach.
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass, USA.
authors.forename: M
authors.initials: M
authors.lastname: Ferrigno
authors.forename: N
authors.initials: N
authors.lastname: Tahir
authors.forename: C W
authors.initials: CW
authors.lastname: Connor
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D001783:Blood Flow Velocity / Q000502:physiology; D002248:Carbon Monoxide / Q000378:metabolism; D002302:Cardiac Output / Q000502:physiology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003198:Computer Simulation; D004242:Diving / Q000502:physiology; D006801:Humans; D007222:Inert Gas Narcosis / Q000503:physiopathology / Q000517:prevention & control*; D009584:Nitrogen / Q000493:pharmacokinetics*; D011652:Pulmonary Circulation / Q000502:physiology*; D012016:Reference Values; D012767:Ships; D012985:Software Design; D013366:Submarine Medicine; D013997:Time Factors
chemical_list: D000319:Adrenergic beta-Antagonists; D002248:Carbon Monoxide; D009584:Nitrogen