**6.3 Technique**

Airway management in space, with all its challenges, is amplified for nonmedical personnel. Checklists and other such simple and minimal protocols will immensely help to streamline the process [7].

A mandatory pre-anaesthetic evaluation of all space travellers, before their departure from Earth, is recommended. A thorough airway assessment and detailed clinical documentation for every space traveller would prove to be valuable in case of emergencies. Clinical documentation may include details like the size of the endotracheal tube, requirement of additional intubation equipment, etc. Checklists for airway management and anaesthesia may include details of that equipment that must be available conveniently with the corresponding drug doses calculated and made available.

Conventional laryngoscopy and intubation with the patient placed in the sniffing position, without the use of restraints, is likely to have a high failure rate in microgravity. The head and neck move out of the field of vision during direct laryngoscopy, due to the anterior force exerted. It is not possible for the hand—the one not holding the laryngoscope—to stabilise the head–neck as well as direct the endotracheal tube toward the glottic opening simultaneously [64]. Anaesthesiologists exert a force of about 40 N, lasting for about 10–20 s during direct laryngoscopy. This force is sufficient for a 70 kg human to move about 0.3 m in 1 second in microgravity. Use of a restraint (**Figure 1**) will allow the stabilisation of the head and neck, so that the hand not holding the laryngoscope is free to direct the endotracheal tube toward the glottic opening [64]. However, there are some limitations in applying them during a medical emergency. Data indicates that it takes 5 to 10 seconds for strap application [71].

#### **Figure 1.**

*Crew medical restraint system used during the space shuttle missions. Restraints hold the patient in place and allow the operator's hands to be free. Source: Photograph S81E5933 - STS-081 - RME 1327 - Crew Medical Restraint System (CMRS); "STS-81 pilot Brent Jett straps mission specialist John Blaha into the Crew Medical Restraint System (CMRS) in the Spacehab module." January 1997; File Unit: STS-81, 4/12/1981 - 7/21/2011; Series: Mission photographs taken during the space shuttle program, 4/12/1981–7/21/2011; Record Group 255: Records of the National Aeronautics and Space Administration, 1903–2006; National archives at College Park, Adelphi road College Park (MD). Accessed on 30th April, 2021.*

**207**

**7. Conclusion**

ing the patient [64, 71].

**Figure 2.**

stabilise the victim's head [72].

*Challenges to Airway Management in Space DOI: http://dx.doi.org/10.5772/intechopen.98932*

A self-retaining, bivalved laryngoscope may allow the hand that is holding the laryngoscope to be free in order to help stabilise the head and neck. The head and neck of the patient may also be stabilised between the knees of the person intubat-

*An artist's representation of the sit down-lean back technique. (Image provided by the author.)*

During cardiopulmonary resuscitation, stabilising the head by gripping it between the knees (**Figure 2**) is recommended [71]. Even though this technique provides a distant view of the glottic inlet, it is stable and saves time. This technique may be compared to the "sit down–lean back technique" used by paramedics to

In the case of elective procedures, it is advisable to use restraints. If exercise of restraints is not feasible then extra tracheal airway devices may prove to be useful. It is not essential to position oneself at the head end of the patient for use of the extra-

Restraints are not necessary for either the patient, the equipment or the operator—on Mars—since its gravity is approximately one-third of Earth's gravity. In

Robotic intubation may not find an application, at least in the foreseeable future, as far as space is concerned, in view of the undue up-mass they constitute and given

Recent technological advances and scientific discoveries will lead mankind to realise its aspirations as a spacefaring species. If we are to support an enduring human exploration of space, we would have to rapidly update our understanding of human physiology, as well as find better ways to manage medical and surgical

tracheal airway devices, in the interest of saving time [64].

microgravity, however, restraining is recommended [35].

that the chances of using this technique is remote [1].

*Special Considerations in Human Airway Management*

immensely help to streamline the process [7].

takes 5 to 10 seconds for strap application [71].

*Adelphi road College Park (MD). Accessed on 30th April, 2021.*

Airway management in space, with all its challenges, is amplified for nonmedical personnel. Checklists and other such simple and minimal protocols will

A mandatory pre-anaesthetic evaluation of all space travellers, before their departure from Earth, is recommended. A thorough airway assessment and detailed clinical documentation for every space traveller would prove to be valuable in case of emergencies. Clinical documentation may include details like the size of the endotracheal tube, requirement of additional intubation equipment, etc. Checklists for airway management and anaesthesia may include details of that equipment that must be available conveniently with the corresponding drug doses calculated and

Conventional laryngoscopy and intubation with the patient placed in the sniffing position, without the use of restraints, is likely to have a high failure rate in microgravity. The head and neck move out of the field of vision during direct laryngoscopy, due to the anterior force exerted. It is not possible for the hand—the one not holding the laryngoscope—to stabilise the head–neck as well as direct the endotracheal tube toward the glottic opening simultaneously [64]. Anaesthesiologists exert a force of about 40 N, lasting for about 10–20 s during direct laryngoscopy. This force is sufficient for a 70 kg human to move about 0.3 m in 1 second in microgravity. Use of a restraint (**Figure 1**) will allow the stabilisation of the head and neck, so that the hand not holding the laryngoscope is free to direct the endotracheal tube toward the glottic opening [64]. However, there are some limitations in applying them during a medical emergency. Data indicates that it

*Crew medical restraint system used during the space shuttle missions. Restraints hold the patient in place and allow the operator's hands to be free. Source: Photograph S81E5933 - STS-081 - RME 1327 - Crew Medical Restraint System (CMRS); "STS-81 pilot Brent Jett straps mission specialist John Blaha into the Crew Medical Restraint System (CMRS) in the Spacehab module." January 1997; File Unit: STS-81, 4/12/1981 - 7/21/2011; Series: Mission photographs taken during the space shuttle program, 4/12/1981–7/21/2011; Record Group 255: Records of the National Aeronautics and Space Administration, 1903–2006; National archives at College Park,* 

**6.3 Technique**

made available.

**206**

**Figure 1.**

**Figure 2.** *An artist's representation of the sit down-lean back technique. (Image provided by the author.)*

A self-retaining, bivalved laryngoscope may allow the hand that is holding the laryngoscope to be free in order to help stabilise the head and neck. The head and neck of the patient may also be stabilised between the knees of the person intubating the patient [64, 71].

During cardiopulmonary resuscitation, stabilising the head by gripping it between the knees (**Figure 2**) is recommended [71]. Even though this technique provides a distant view of the glottic inlet, it is stable and saves time. This technique may be compared to the "sit down–lean back technique" used by paramedics to stabilise the victim's head [72].

In the case of elective procedures, it is advisable to use restraints. If exercise of restraints is not feasible then extra tracheal airway devices may prove to be useful. It is not essential to position oneself at the head end of the patient for use of the extratracheal airway devices, in the interest of saving time [64].

Restraints are not necessary for either the patient, the equipment or the operator—on Mars—since its gravity is approximately one-third of Earth's gravity. In microgravity, however, restraining is recommended [35].

Robotic intubation may not find an application, at least in the foreseeable future, as far as space is concerned, in view of the undue up-mass they constitute and given that the chances of using this technique is remote [1].
