Going Under: Anesthesia Answered with Dr. Brian Schmutzler

Anesthesia In Space

• Dr. Brian Schmutzler • Season 4 • Episode 12

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In this episode of Going Under: Anesthesia Answered, Dr. Brian Schmutzler and Vahid Sadrzadeh go into outer space.

What would it really take to deliver safe anesthesia in orbit? Blending new microgravity research with practical anesthesiology to map the risks, the tools, and the best‑bet strategies for keeping a patient stable when everything floats.

If you’re curious about space medicine, anesthesiology, or how frontier research translates into better everyday care, this conversation lays out the emerging playbook. 

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SPEAKER_01:

This is going under Anesthesia Answer with Dr. Brian Schmutzler on Fahid Sad Rosani, and we're brought to you by the Butterfly Network.

SPEAKER_00:

Yes, we are. All right, I'm gonna let you in on something that's completely changed the way that I practice. I've been using butterfly pro butterfly probes for years. It's a portable ultrasound. I just say that five times fast. It's a portable ultrasound that plugs right into my compatible smartphone or tablet, and I can start scanning at the bedside in seconds. If you use the older version, even if you're new to the handheld ultrasound game, let me tell you why this IQ3 is a game changer and really impressive. First off, having an ultrasound that literally fits in my pocket means I can move faster, whether it's vascular access, procedural guidance, or just getting real-time insights from my patients. And the tech inside this tiny device is pretty incredible. Biplane imaging lets me see short and long access simultaneously, which is huge for procedural guidance and honestly a great tool for learners. The new needle out of plane preset even shifts the scan plane digitally so I can see the needle's tip sooner, which makes a real difference when precision matters. And the image quality, honestly, the IQ3 holds up against some of the high-end cart-based systems I've used. That's pretty impressive for something this portable, even though I can't talk about which systems they are anymore. Uh, if you're looking for a device that supports your practice, I can't recommend a butterfly IQ three enough. And right now they're running a special offer. You can get$750 off the latest IQ three. Check it out at Butterfly Network.com. I'm also seeing they're having a Black Friday sale, so I don't know if that's uh combinable or not. You'd have to check.

SPEAKER_01:

We are we do every podcast, we put the link below so you're able to check it out for yourself. Yes, yes, uh Butterfly Network. Butterfly Network. Appreciate you guys sponsoring the podcast. And of course, uh a fine collaborator of yours is uh Fabletics. That's right. I will you walked in with the suit, and I'm like, is a suit that comfortable to wear during the podcast? Because you normally wear scrubs.

SPEAKER_00:

That's right. That's right.

SPEAKER_01:

But Fabletics, you and Fabletics are are collabing on this nice suit.

SPEAKER_00:

We are, we are. Look at this. Look at this.

SPEAKER_01:

You have broad shoulders too, so it's really comfortable, right?

SPEAKER_00:

It is very, very comfortable, yeah. And it's a a blue suit with a white shirt. Um, I can stand up and show you. Yeah, I know you're you'll show some of it on the podcast.

SPEAKER_01:

Yeah, we'll show some of it on the uh podcast.

SPEAKER_00:

But yeah, I so that's what I I honestly, so um, you know, we've been filming at the studio much of today. Um, and I was already here and it came to the house, so I had Alicia bring it. Yeah. And um, when she brought it, I went out there and looked and I was like, oh, she brought the wrong thing, thinking like they don't have a suit, but they have a suit.

SPEAKER_01:

Have you been at the studio all day?

SPEAKER_00:

I have. You've just been working away. Yeah, I've been going back and forth between work and filming stuff, yeah.

SPEAKER_01:

Oh, so you but but you just camped out here.

SPEAKER_00:

Yeah, Dr. CN had came over for a little while. We filmed some stuff. Nice. I had some stuff I had to film, so yeah.

SPEAKER_01:

Awesome.

SPEAKER_00:

It's been it's been a good day.

SPEAKER_01:

Awesome. It is gonna be a spectacular podcast here today because we are talking about anesthesia in space. Yes, we are. I do have a question before you before we get started on this. Yeah, yeah, yeah. Because we're gonna go through the science of this and how is it happening and how are they testing it? What are what is the possibility, and maybe this is uh more of what you believe in. What is the possibility that we are actually doing surgery in space in our lifetime?

SPEAKER_00:

Um eighty-five, ninety percent. Whoa. I I think over time, you know, the the International Space Station, I think was kind of just a test. I think eventually they're gonna create entire kind of colonies in space or Mars or whatever, you know, in in it. Not in our lifetime, though. I think in our lifetime. In space, probably. I don't know if we'll get to Mars in our lifetime, but I bet in space. In space. Yeah. Like colonies of satellites and yeah, I bet there'll be some of that. So interesting. I give it a high percentage.

SPEAKER_01:

Well, Elon Musk uh likes what you're talking about.

SPEAKER_00:

Yes, he does. And so I if I'm still alive and practicing, I'll have to know how to do anesthesia in space. I'll come film it.

SPEAKER_01:

We can definitely do that. So we're talking about um anti-gravity, is what it's called. Microgravity, I'm sorry, microgravity. Testing anesthesia in space. And there was a uh a researcher and an article, um, and we're gonna talk about this in just a second. But before we get to this, I want to kind of layman's terms here. Yeah, how weightlessness affects the body. Because we we know about when you're in space, right, and you're circling Earth or wherever you are, right? And most likely if you're listening to this, you're not in space, but right if you are in space, you're in microgravity or no almost no weightlessness, because the the the ship is traveling at a rate of speed. Right, right. There is no gravity in space. Once you once you get out of the gravitational pull of the earth, yeah, you have no gravity. So my question to you is what does the what properties does the body contain that makes it weightless when you are in outer space, right? Yeah. So we look this up. Go ahead, yeah, you go. Yeah, so like how weightlessness affects the body. And so this is what it said said when astronauts live in microgravity, right?

SPEAKER_00:

Because it's not true, zero gravity, right? You you would have to be so far away from any gravity source for it to be zero, but it's not not enough to be uh on the moon, zero gravity, right? No, there's still micro gravity. Yep, yeah. There's gravity because the sun, the sun creates the pull, the pull, yeah.

SPEAKER_01:

So their bodies begin to change because many systems evolve to work with gravity. Yeah, without that consistent pull, the body adapts in noticeable ways. One, yeah, the bones get weaker, so you have density loss, right?

SPEAKER_00:

So so your bones, this is why they say as you age, you need to continue to do athletic activities.

SPEAKER_01:

Because then you'll be weightless. No, no, no, no.

SPEAKER_00:

You're right, because it contributes to the yeah, so so the bones build based on stress. And so if you don't, let's say you the being in space is the same as laying in bed, you know, for weeks at a time, right? Your bones get weak because if they don't have the stress, and this is actually this kind of goes back to a book that's not totally related, but um uh anti-fragile is the name of the book. So we we should talk about that at some point. But your your your body needs a certain amount of stress, your bones need a certain amount of stress for them to grow and harden. So if you don't walk on them at all, you get weak. And so that's that's part of it, yeah.

SPEAKER_01:

So uh astronauts can lose one to two percent of bone mass per month. Wow, if they don't exercise. That's crazy, yeah.

SPEAKER_00:

And per month, one to two pounds of bone mass per month, yeah. Wow.

SPEAKER_01:

So I mean you could be looking at in what 36 to 48 months if you're in outer space. Yeah, you've lost most all your bone mass, yeah. Wow, yeah.

SPEAKER_00:

The second thing they mentioned there were those astronauts who got stuck.

SPEAKER_01:

Yes, yeah, yeah, for like a year. Yes, yeah, yeah.

SPEAKER_00:

Okay.

SPEAKER_01:

So I mean, they had to exercise probably twice as much as we would on Earth, right?

SPEAKER_00:

I still don't think that you can match the the way that gravity causes that, you know, like even if you're exercising in space, right? They're riding a bike or whatever. Right. I don't think that you can match that same force of like running or lifting weights or whatever. I just don't think you can match it.

SPEAKER_01:

It's almost like running with you've run with like one of those anti-gravity things before. That's is that what it's like? I don't know.

SPEAKER_00:

I've never been to space.

SPEAKER_01:

So we can make that happen.

SPEAKER_00:

No, you can't. I don't believe you. But if somebody wants to take me to space and they're ready to clean up my vomit because I don't do well with you can pay Amazon$250,000 though.

SPEAKER_01:

For what? To get into orbit, you know, like the Katy Perry thing. Oh, I thought you meant for them to clean up my vomit. I mean, that's my extra.

SPEAKER_00:

It's another 50k for them to clean up my vomit.

SPEAKER_01:

It's like it's like a New York taxi. You gotta pay thirty three hundred dollars for them to put it through the car wash.

SPEAKER_00:

So I I I am very bad at at motion sickness, so I would not do well.

SPEAKER_01:

But anyway, the second thing they say is muscles shrink, uh-huh. So you get muscle atrophy.

SPEAKER_00:

Yeah, so atrophy means that it just yeah, that that the um you you actually truly lose muscle fibers, right? So you so the way that muscle works is the same way, right? You break it down in order to build muscle, you have to break it down first, it heals itself and then grows. Um, and you you just in space, again, you don't have anything, any resistance to go against. So, like, even if you had like, for instance, a band, the resistance is so much less because there's no gravity, right? So even when they're working out in space, they're they're delaying the effects a little bit, but it's not the same as as truly lifting weights like you do on Earth.

SPEAKER_01:

So they say endurance decreases, so astronauts exercise two hours per day to reduce that.

SPEAKER_00:

Two hours per day. Come on. Need to be six, seven hours a day.

SPEAKER_01:

Fluid shifts upward and to the head, right? So it says without gravity pulling fluids towards the legs. So it goes towards the head, yeah, face looks puffy, legs get thinner, yep. Chicken legs, it says.

SPEAKER_00:

I wonder if that helps if you like go upside down, though, in the space station.

SPEAKER_01:

This is like uh interstellar thing now. Now you're like pressure increases in the skull, which can affect vision. Yep, yeah. This is why astronauts' eyesight changes over long missions. Yep. Number four, balance system gets confused.

SPEAKER_00:

Yep, yeah, because there's no gravity for you to know. So you might be upside down, you wouldn't be able to tell, and then you get back to Earth and you're like, the heart works less hard.

SPEAKER_01:

Yep. So it's less to push against. Correct. Since since it doesn't need to pump blood against gravity, right, right. The immune system weakens.

SPEAKER_00:

Yeah. Uh yeah, I mean, that's just because you're likely not exercising or eating as much. Genes behave differently.

SPEAKER_01:

Yeah, I don't know the answer to why that is, but uh it says gene expression in space, it can show changes in gene expression that return to normal when astronauts come back to earth.

SPEAKER_00:

So the epigenetics, yeah. I don't know. I don't know. I'm not a geneticist, and that's very complex. But yeah, I would assume you know you change your environment, right? So you find even people who move from like you know, a cold environment to a warm environment, their genes change, the epigen epigenetic expression of their genes changes. So that doesn't surprise me.

SPEAKER_01:

And then the final thing is it does it say astronauts recover? And it says yes, most recover days to it readapt balance, weeks for muscles, months or years for bones, and some vision changes may be permanent. So here, one question before we dive into the anesthesia in space, because now we know molecularly what the changes are what pathologic teams are.

SPEAKER_00:

Yeah, yeah, yeah.

SPEAKER_01:

If you're in a space mission, or let's say you have colonies, yeah. How does that work? If you're losing all of these things, yeah, do you create gravity?

SPEAKER_00:

You'd have to figure out a way to create gravity.

SPEAKER_01:

I don't you couldn't we haven't done that yet? No, I don't think so. So we just microgravity is all we have, so you would have to do all these things and you still just the last nine months in space. Yep, yeah. So colonies seems very difficult unless you're creating gravity. I'm sure. Elon, it's to you, man.

SPEAKER_00:

Create some gravity. Space. So now that we know all of this. Yeah. So so here's the background on why we're talking about this, right? So I read this article. Um, it's from Fraser Health, uh, Royal Columbian Hospital to Micro uh from Royal Columbian Hospital to Microgravity, testing the role of anesthesia in space. And so they talk about this um anesthesiologist who who wanted to be an astronaut when he was growing up and you know all that kind of stuff. And then he he became an anesthesiologist and got connected with some other people at at the Royal Columbian Hospital who were who were doing research, and so now he's researching what it would be like to do anesthesia in a micro microgravity or zero gravity environment. So it's crazy, right?

SPEAKER_01:

So you want like if you had to, yeah, if you had to your knowledge, no, never. There's never been surgeries.

SPEAKER_00:

Not that I know of, not that I know. I'm looking, I'm looking back.

SPEAKER_01:

So what happens if you cut yourself in space?

SPEAKER_00:

Well, you could stitch it. That's not really surgery, right? So so what are things that could happen in space? You could get, well, yeah, the blood's gonna go everywhere, but so what could happen in space? You could have an a uh appendicitis and have to get your appendix out. Okay. That's a reasonable thing that could happen in space. Tonsils? Uh tonsils aren't it aren't really anything, yeah. Um, you could get like a bowel perforation, you know, that could happen. Diverticulitis could happen. Um, you know, you could get a uh impaction, right? So if you ate your food too too big a piece of food too quickly, you get an impaction where you'd need anesthesia and certainly.

SPEAKER_01:

What if what if I mean I'm kind of surprised this hasn't happened in space, any of these that you're saying? Yeah. What if you had a heart attack in space? What happens? Yeah, does it did the fibrillator work the same? Oh, that's a good question.

SPEAKER_00:

Uh so it's electrical, not it would probably work similar, yeah. I would think because it's electrical, right?

SPEAKER_01:

So you can't really perform surgery though. I mean, how do you get a stint in? Well, a stent would go through a vein.

SPEAKER_00:

Um and the veins or through an artery. Did the arteries expand? It shouldn't change a whole lot. Okay. I think you could still do it. You would just have to have all the equipment. And how do you do this without gravity though? How do you perform surgery?

SPEAKER_01:

I don't know, you'd be like, Like, my mind is blown right now. So they don't have like gravity chambers that you can like think so.

SPEAKER_00:

No, no. So so I think if you if you had a table. You would have to be tethered. Right. You you you would have a table that was that was bolted to the machine, and then you would get tethered.

SPEAKER_01:

It would have to be tethered on all four corners, yes, if I'm not mistaken. Right, right, right.

SPEAKER_00:

And then the person would have to be strapped down. Yep, and then you, and then you as the surgeon would have to be strapped down as well, right? Because you don't want to float away while you're operating. So I it's crazy. It's crazy to think about. So, how do they do it, right? So we were looking through this article, the experiments, they injected a and all they did, they really only did like a a spinal, right? Basically, so they injected a 3D printed model of a spinal canal with anesthetic drugs during parabolic flight, meaning moments of weightlessness. They found that microgravity medication did not float upward, rather, it seemed to spread more slowly. So you could do a spinal and numb somebody up in space according to this, that it wouldn't just float up and then cause what's called a high spinal, right? Where I mean, like if you injected it and it went too high, right? That causes a problem. You don't breathe anymore, you don't your heart doesn't pump. Like, there's a lot of things that can happen if you get a high spinal.

SPEAKER_01:

So anesthesia. Yeah. Let's explain how it works on Earth.

SPEAKER_00:

Yep. Yeah. So so um there's there's obviously yeah, we've talked about all the different kinds. So there's general anesthesia, there's IV anesthesia, MAC, and then there's regional anesthesia or spinals and and uh epidurals. Yeah, so so the volatile anesthetics, those are the things we help put you to sleep with with the mask, and the IV anesthetics would actually work better in space. So you need less of them in space. Okay. So the reason for that, and some of this I'm reading, I mean, we did the research, but some of this I'm reading just because it's it's hard to remember as we're talking on a podcast. Um, so reduced circulating volume. Okay, so we talked about this, right? There's there's less actual fluid in your body, um, smaller heart because you're gonna have atrophy, right? The muscles of your heart also atrophy.

SPEAKER_01:

The heart's a muscle, so you're gonna have atrophy.

SPEAKER_00:

And and then um, and then head-down fluid overload state. So all of that would mean that they're more sensitive to the anesthetics, IV and inhaled, so you'd have to use less of them.

SPEAKER_01:

How do you recover? Do you recover as quickly or is it a longer time to recover?

SPEAKER_00:

So likely would have a longer time to recover because again, the volume of distribution is bigger, so it's harder for those medications to get in and out of your body.

SPEAKER_01:

Uh, so if you're asking where they did all this research, it's pretty cool. Yeah. Uh, in a A310 Airbus Zero G. So they tested it in France just to see how the drugs everything worked would work. Yep. The the the question, I would love to get them on the podcast, by the way. That would be great. Yeah, the question is the question is how much money did this test cost?

SPEAKER_00:

Oh, I don't know. It doesn't say in the article, does it? I don't think so. Yeah, I didn't I didn't think I didn't see it in the article, but what they did is let's talk about their experiment.

SPEAKER_01:

So they they injected the 3D printed model of the spinal canal uh during the weightlessness flights. Yep, with with the bupivacaine, which is the numbing medicine. Um, and again, you said it spreads more slowly, so it has more of an effect.

SPEAKER_00:

Uh probably a longer effect, but over a shorter distance. I think what they're most concerned about though was if it would, because of the weightlessness, the drug would just because uh again, everything's going to the head, right? It's not going to the legs. If because of the weightlessness, it would all go up to the brain and cause a high spinal. Right. What this showed is at least in theory, if you had to do surgery in space, you could do a spinal anesthetic. Right? So I could numb you from your chest down and then do surgery awake if you had to. Because you're numb. Got it. Yep.

SPEAKER_01:

So you could do any surgery you wanted to.

SPEAKER_00:

Anything from the belly button down, basically. Yeah.

SPEAKER_01:

The the interesting thing is they tested the anesthesia part of it. Is that the first part? Or like you know, if you're Dr. C in, yeah. If you're, you know, whoever, you know, you could do it as long as you had the anesthesia part, correct?

SPEAKER_00:

Well, as long as you're strapped down and you're not floating all over the place. But yeah, I mean, I we do spinals for his cases for his total total knees and total hips. So yeah, he could, as long as the spinal worked, he could probably do surgery in space. So why do we care about this? I think that's the biggest question. Yes. So I mean, I I think again, I think that there is gonna be more, especially with this um sort of uh movement back towards space. Space interests. Right, NASA, NASA was very popular for a while and then sort of went out of favor. And so I think with Elon Musk, with SpaceX, and then with the new renewed interest in NASA, I think there's gonna be a lot more space missions. And by by just the odds, somebody's gonna have an emergency in space that needs to have an anesthetic and surgery. It's gonna happen at some point, it's got to.

SPEAKER_01:

You know, you just think of of um all of those that have been in space, right? What damages have I mean, have they studied those people? Yeah, you know, I haven't dealt with that. Like Buzz Aldrin.

SPEAKER_00:

Have they studied I mean, a lot of them lived into their 80s and 90s, so maybe not, you know? But they also didn't spend weeks and weeks, they spent a week or 10 days or something, you know.

SPEAKER_01:

So the question is, uh you as an anesthesiologist, what do you do with this information and the and and the study? Like you take the numbers, do you do you study this and say, How can I use this practically on earth?

SPEAKER_00:

Yeah, so I I think some of this would relate to maybe going and doing things at at high altitude. You know, that's what I would think. Maybe, you know, sure, maybe at some point I perform an anesthetic at high altitude. I think not for me personally, because I'm not in the military, but I think this this really would help in the military, right? Because you can say, all right, well, I'm in a submarine, right? And so maybe the exact opposite applies because I'm under high pressure, high um, you know, gravity, right? The gravity's probably it's pulling more down under the ocean, right? You've got all that stuff above you, all the water above you, right? Maybe you take the opposite there. I think I think there's a lot of implications for doing anesthesia, what we call non-OR anesthesia, right? Doing anesthesia not in your typical operating room with all of the fancy things you need where you know exactly what's going to happen. I think the implications are this is how things work outside of the OR.

SPEAKER_01:

You know, it just it's so mind-boggling. It is, you know. I mean, what what takes me back to Interstellar, yeah, which is one of my favorite movies, by the way.

SPEAKER_00:

That is a great movie, yeah.

SPEAKER_01:

How are we shaping the next 10 generations beyond just us? Yeah. Oh, yeah. You know, we care about what's happening not only here, but how do we you know what if something happens to our planet? Yeah. Could we go to Mars? I mean, that's that's can we live? Yeah, can we live in outer space? Yeah, if we had to. Yeah, you look at the Jetsons, right? Yeah, meet George Jetson.

SPEAKER_00:

And this, and this is one of the things you would have to be able to do anesthesia and surgery. If you spend any amount of time in space, high you know, large populations in space, you're gonna have to be able to do anesthesia. So so we there's some more things though. So, like airway management, right? So we as anesthesia, and anesthesia providers, we're airway experts, right? So no gravity means that everything floats, vomit, secretions, blood, everything, right? And because again, we talked about like unless everybody's strapped down, it's gonna be hard to get you know in one spot. And when we innovate, we kind of we we need all the anatomy to line up. So that'd be a big thing.

SPEAKER_01:

Um yeah, I mean, if there's any any food in the belly, if there's anything, I mean, like, can't be on GLP ones in outer space, and get surgery.

SPEAKER_00:

Yeah, and and so what would we do in space? All right, so we would try to avoid having to innovate, right? Because that's gonna take a lot of like strapping down. So using something that would allow the patient to still breathe, but be anesthetized. So that's ketamine. Ketamine is a drug that we use. We can use it intramuscular or we can use it IV. You already use a low amount of ketamine. We do, yeah. So, how how low of an amount? It would have to be higher in space. We use it sort of an adjunct, we don't necessarily use it often as the main anesthetic. So we would use that as a main anesthetic and then put in an LMA. So that way you don't have to have the anatomy, right? You just slip that LMA in. And if they're breathing on their own because of the ketamine. Who's willing to try this? I don't know, not me.

SPEAKER_01:

I mean, have they tried it on rats? Have they tried it on uh any living being yet? Yeah, I don't know if they've done surgery in space on on animals. You would imagine they probably you would have imagined they had to if they're doing this anti-thing.

SPEAKER_00:

But but so this goes back to even generally studies on mice and rats, while important probably are not totally indicative of this to humans, yeah. Yeah, they're not a per they're not a perfect uh equivalent. Um okay, so we already talked about like medications. The medications all work differently, right? So faster onset, more effect of those drugs, and harder to get rid of. So we talked about that a little bit. And then monitoring, you don't even think about it, but how would you monitor anesthesia in space, right? On on Earth in an operating room, I've got my you know, I've got my monitor up there, I've got pulse ox, all that kind of stuff, right? So, so um blood pressure cuffs wouldn't work as well because again, the the fluid doesn't go all the way out to the arms, right? So you'd have to have some sort of central So it's not a right, it's not the right measurement. Yep, it wouldn't be accurate. So you would have to probably put in like an arterial line or even like a central arterial line of some sort. If you put in a line, right?

SPEAKER_01:

Let's say, I mean, you're on a table and you have a you're you're on a table in the operating room in gravity and you have your arm laid out. Yeah, right? Yeah. They put the whatever in, the needle in. Yeah. In space, if you were even strapped down still, would that float?

SPEAKER_00:

Like, oh, everything's floating, yeah. You would have to hold it much more tightly for sure. Yeah. It'd be tough. It'd be tough. And then uh, and then the uh the electrodes for the EKG probably wouldn't stick, right? Because they want to float up too, right? And they're metal. So that's another thing.

SPEAKER_01:

You would have to create anti-gravity. I mean, like that that is, I think, in my mind, yeah, but just necessity.

SPEAKER_00:

What happens if it's tomorrow? Like, there's people in the International Space Station right now. What if somebody needed an appendectomy tomorrow? You'd have to be ready for it.

SPEAKER_01:

Yes, but you'd have to also have a medical personnel, like you have to have a doctor on board. A lot of them, I think, do a lot of our doctors? I think there are they train physicians? Yeah, I think so. Yeah. So I mean, like, has it not happened that anybody has had to do a medical emergency surgery in space?

SPEAKER_00:

What if you have to do the Heimlich maneuver? Does that work? Let's uh well, not as well. I don't think it would work as well because you don't have the gravity to pull it out. Yeah. Let's see what Chad says about. Let's see if ChatGBT says has there ever been a surgery on a human done in space? Let's see what it says. No, as of 2025, there has never been a full surgical procedure performed on a human in space. Which is crazy.

SPEAKER_01:

Interesting to me. Yeah, it's crazy. Okay. Why surgery in space is hard in general. Yeah. Microgravity. Yep. Makes everything float. Right. Floating droplets. Yep. Floating equipment. They can block a surgeon's view. Yep. Two, air circulation spreads contaminants.

SPEAKER_00:

Oh, that's true. You don't have laminar flow. So all of our operating rooms have what's called laminar flow, where it where it pushes the air out, right?

SPEAKER_01:

So this is part of your vent system.

SPEAKER_00:

Yeah, it pushes the air out, right? So it's constant airflow, okay, pushes the air out. So any infectious things, right, would in theory be pushed out of the room. So you'd have you don't have that in space. So all of that would be.

SPEAKER_01:

The ISS constantly circulates air. Okay, so that's good. But the floating droplets or particles could again into the eyes and nose, yeah, the ventilation system and the electronic equipment. Yep. So the surgical area must be completely sealed off from everything else.

SPEAKER_00:

Interesting.

SPEAKER_01:

Right. I didn't even think of that. So the ISS, how does the ISS have constantly circulating air if it's a microgravity? I don't know.

SPEAKER_00:

It must it must have blowers that push it through.

SPEAKER_01:

Number three, astronauts aren't surgeons. They have basic medical training, but they're not specialized. So you'd have to bring somebody up with you or take somebody up there. Yep. And who knows if that's too late or not?

SPEAKER_00:

Right, right. And how long does it take to get them up there? How many surgeons are certified astronauts? Like that, there's a lot of questions here.

SPEAKER_01:

Equipment must be compact and adapted. Yep. So traditional hospital tools are too large. Yep. Yep. So that's when we talk about the butterfly. Oh, yeah, yeah. I bet you could do the butterfly space. And how accurate would the butterfly be in space? Well, it's an ultrasound, so it doesn't matter. It shouldn't matter, yeah. Now, yeah. Listen, butterfly, I gave you the idea. Put it on the ISS. Put it on the ISS. I'm talking to you, butterfly. I love it. I don't love it. The equipment doesn't work well without gravity and needs power. Yep. And special sterilization systems. Yeah.

SPEAKER_00:

So this is this is what this is what it says here. NASA uses closed surgical chambers.

SPEAKER_01:

And they've developed things that are compact, sealed, magnetic, and anchored tools. The instruments, the fluids, the secretions. But again, you're spending millions and billions of dollars on creating tools, right? Yep. And how much of the hospital budget is spent on tools?

SPEAKER_00:

Oh, that's a great question. Um, you know, I I think so over time the cost of those tools becomes less and you can reprocess them, right? So you you basically have enough equipment to do your surgeries and then reprocess over and over again. Do you throw those tools out or no, no, no, they reprocess? Sterilize and use them again. Use them again. Yeah. So you couldn't, I don't think you could do that in space because I mean, even a even a small sterilizer is like half the size of this room. Yeah. So you're not going to take that up into space.

SPEAKER_01:

Uh robots. That's how they have performed. You know, yeah. Um, using artificial gravity. Uh they said that experiments on animals have been done. Okay. Um but surgical tasks, cutting in robotic tests, and fluid control experiments.

SPEAKER_00:

But even then, like I said, a rat or a mouse is not a human.

SPEAKER_01:

Well, and this, right, it's not. And and you know, the ultimate question of what we've asked is why does this matter? Yeah. Mars, yeah. Astronauts will be months away from Earth. Yep, yep. Medical evaluation, evacuation is impossible. Yep. Communication delay can be five to twenty minutes, and uh the crew must be able to handle medical emergencies on their own. Yeah.

SPEAKER_00:

So, so while so, you know, I guess we bring all this back. Yeah. This this is intellectually interesting. Do I think this is something I'm ever gonna do? No. Do I think the majority of anesthesiologists, surgeons, whatever, are ever gonna do this? No. But it brings up a good point. What are things we learn a lot from NASA, right? Like NASA created Velcro. Right? 100%. So that and that's been a huge game changer for you know life, public in general, right? So we're learning a lot of things from this of how do we do anesthesia in a, you know, a dangerous or different or out of OR environment. And I bet they create a lot of tools this way, right? Right. I mean, I'm sure that there's somebody at some point they're gonna create something that's gonna just revolutionize the way either we do anesthesia in austere circumstances or surgery.

SPEAKER_01:

Well, and to be honest, I mean, how many hikers go to Nepal? How many hikers go to Mount Kilimanjaro?

SPEAKER_00:

They just leave them on the mountain, though.

SPEAKER_01:

They leave them on the mountain. Yeah. But does this in maybe impact? Yeah. Like I have dreams of one day going to base camp. I don't. No? None. Base camp. I want to go to base camp. I don't know if I want to necessarily climb Mount Everest. Nope. But this begs the question because you're doing stuff in that high altitude, does this change the way?

SPEAKER_00:

Yeah, that's like a classic board question, right? Like, do if you take the volatile anesthetics, and I don't honestly I don't remember the answer at this point, but if you take the volatile anesthetics, do you need to use more or less in in a um in a uh an environment that has number one less oxygen and number two is higher altitude? I think the answer is like the there's things that balance out, so you use the same amount anyway. Like the the dial, you turn the dial to the same number basically. So but just the manpower to get there and that yeah, yeah, yeah. But but no, I mean that's a board question though. Like how do you using the Ballatali Anesthetics, do you change anything? And I I again it's been 15 years or whatever, so I don't remember at this point, but yeah, man, what an interesting topic.

SPEAKER_01:

Very I am um I love outer space, to be honest. I love our our space missions and and just kind of I think it's just very interesting um to explore what's not in our yeah, not in our normal world in our world, right? I mean, how did you know this goes back to the questions of how was medicine formed? How was it, you know, like how did they all of a sudden discover anesthesia? Well, I mean, they had to experiment, right? Oh yeah, yep, a hundred percent. How did they discover that, you know what? Like we have to figure out a way um for heart attacks, and how do they go, you know? So I mean, everything there's a starting point. Yep. And so we're at a point in human history in technology where we can have a starting point on this conversation. Yep. Uh so that makes it interesting.

SPEAKER_00:

Yeah. So so I think um just to tease, I think we're gonna do a 12-part series next, right? Didn't we talk about that? We did, yeah, doing a 12-part series. So um that's gonna start probably next week. Yep. And we'll go through December. We'll take a couple weeks off, the beginning of January, and then go back to it. So I'm I'm excited. Uh I'm excited for the series. I had I had sort of an epiphany of what we're gonna talk about.

SPEAKER_01:

Awesome. I'm looking forward to it.

SPEAKER_00:

So stick around, yeah.

SPEAKER_01:

All right. Well, this has been going under anesthesia answered, live from outer space. Not really. No, we're not live from Earth and not the ISS or anything like that. Yep, the studio that we're always in. It's Brian's world, and we're just living. Oh, wow. Wow. All right, all right. In a good way, in a good way, in a good way, all right. Fair enough. And we are brought to you by the Butterfly Network. You better be in Outer Space, outer space. We're gonna we're gonna come for you and tell you that. That's right. That's right. We're calling them tonight. All right. Uh thanks you so much. Thank you, and we'll catch you in the next one.

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Dr. Brian Schmutzler

Host
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Vahid Sadrzadeh

Host