JPRS 81599
20 August 1982
USSR Report
SPACE BIOLOGY AND AEROSPACE MEDICINE
Vol. 16, No. 4, July-August 1982
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JPRS 81599
20 August 1982
USSR REPORT SPACE BIOLOGY AND AEROSPACE MEDICINE
Vol. 16, No. 4, July-August 1982
Translation of the Russian-language bimonthly journal KOSMICHESKAYA BIOLOGIYA I AVIAKOSMICHESKAYA MEDITSINA published in Moscow by Izdatel'stvo "“Meditsina”.
CONTENTS
Main Directions and Principles of Psychological Expertise of
CosmonautS ........ eccccccccces TUPUTIELTTELELETELILITTTLT Tree 1 Anesthesia, Surgery and Resuscitation During Manned Spaceflights ... 9 Regional Hemodynamic Changes After Spaceflights Lasting up to 8 Days 14 ' Effect of Optokinetic Stimulation on Operator's Functional State and Professional Work Capacily cesses eccncccccsecevesessescenes 21 Dehydration Therapy for Subjects Exposed to Simulated et Ot UVTI TITITITITTTTTTTTir 26 Study of Operator's Verbal Information in the Course of Complicateu and Combined Activity ......cccecccccccccccesscccccess 33 Use of Voice Communication To Study Operator Activity ........see6- 37
Dynamics of Functional State of Heavy Transport Helicopter Pilots in the Course of Flight Shift ....... TEITETELITITTLETLT TT 42
Controlography Used for Integral Assessment of Mental Work Capacity 46
Seismocardiographic Evaluation of Contractile Function of the Myocardium of Hypokinetic RatS ......seeeees TITTTTITTTTTirT 50
Morphology and Coagulant Function of Human Blood System During Long Exposure to Low Ammonia Concentrations in a Sealed Environment 56
Percutaneous Measurement of Partial Oxygen Tension and Local 8lood Flow in Man During Orthostatic Test ...... WETTTITILITITTTT TT TTT 60
-a- [III - USSR - 20H S&T;
Activity of Rat Adrenal Medulla After Flight Aboard Cosmos-1129 B1oSatellite .ccccccccccccccccces eccccccccccccccccene ecccccccce ecccce 65
Stereological Analysis of Rat Bone Tissue After Flight Aboara Cosmos-1129 Biosatellite ........6... TLITUTTTITTTTTrrriesrrerrit ee eee 70
Changes in Rat Tissue Deoxyribonucleoprotein and Nucleic Acids Following Flight Aboard Cosmos-1129 Biosatellite ........ccceecccceess 74
Morphological Distinctions of Macaca Rhesus Monkey Thyroid Under Normal and Various Types of Hypokinetic Conditions ........ccceeeeees 79.
Effects of +G, Acceleration and Adeturon on Nucleic Acid Content and Other Parameters of Mouse Peripheral Blood .........eeeeeee. ovce 88
Significance of Magnetic Field Parameters to Change in
Evoked Bioelectric Activity of the Brain ....ccccccccccccccccvcvcscece 93 Cytogenetic Effects of High-Energy Charged Particles ...........eeaeees 98 Cytogenetic Effects of Heavy Charged Particles of Galactic Cosmic
Radiation in Experiments Aboard Cosmos-1129 Biosatellite ............ 103 Measurement of Vestibular Asymmetry in Rotation TeStS .......eeeeeeees ° 109
Comparative Evaluation of Informativeness of Three Corrected Orthogonal Leads and Twelve Conventional EKG Leads in Conducting
Functional TeStS .....eeeee0. eccccccccccccs TETTUETITILITTTITTT TTT 112 Diagnostic Use of Enzymatic Test in Experiments on Monkeys ............ 117 System for Automatic Analysis of Rheoencephalograms ........«.. eacanaca 127
Preflight Examination Results Used To Forecast Cosmonaut Endurance of Orthostatic Tests After Spaceflight ......cceeesceecveess 131
Renin-Angiotension-Aldosterone System and Electrolyte Metabolism in Rat Blood After Flight Aboard Cosmos-1129 Biosatellite ........... 136
Epinephrine and Norepinephrine Concentrations in Rat Cardiac Ventricles and Atria After Flight Aboard Cosmos-1129 Biosatellite ... 139
Rat Blood Plasma Corticosterone After Flight Aboard Cosmos-1129 Biosatellite oeeeeeeeee eee eeeee eee eee eee eee eee eee eee eee 143
Deoxyribonucleoprotein and Nucleic Acid Content of Rat Tissues
After Flight Aboard Cosmos-936 Biosatellite ....c.eeeeeeeeees ecccccce 146 Meeting of Editors of Soviet and American Aerospace Journals .......+.+.. 151 New Book on Space Gastroenterology ..... Coe ceccccccccaccccoceccecooses 152 Abstracts of Articles Filed With the All-Union Scientific Research
Institute of Medical and Medicotechnical Information ............. eee 156
» hea
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SPACE BIOLOGY AND AEROSPACE MEDICINE, Vol 16, No 4, July-August 1982
KOSMICHESKAYA BIOLOGIYA I
AVIAKOSMICHESKAYA MEDITSINA
O. G. Gazenko
Meditsina
Moscow
July-August 1982
4 June 1982
1438
"Kosmicheskaya biologiya i aviakosmicheskaya meditsina", 1982
SURVEYS UDC: 629.78:612.821.1/.3]:658.311.44 MAIN DIRECTIONS AND PRINCIPLES OF PSYCHOLOGICAL EXPERTISE OF COSMONAUTS
Moscow KOSMICHESKAYA BIOLOGIYA I AVIAKOSMICHESKAYA MEDITSINA in Russian Vol 16, No 4, Jul-Aug 82 (manuscript received 8 Sep 81) pp 4-8
[Article by K. K. Ioseliani, A. L. Narinskaya and Sh. R. Khisambeyev]
[English abstract from source] This paper attempts to systematize the major objectives and principles of psycho- logical expertise of cosmonauts during their selection and training which may contribute to well-substantiated conclusions.
[Text] Because of the increased duration of spaceflights, greater complexity and fullness of flight programs, greater demands are being made of the cosmonaut, which sometimes border on the limits of his psychophysiological capabilities. The professional activity of a cosmonaut, who is exposed to such specific
flight factors as weightlessness, noise, vibration, sensory deprivation, rela- tive social isolation, shortage of time, etc., require emotional stability, intellectual vigilance and effectiveness, quickness of wit, creative thinking and other psychological traits that assure the speed and adequacy of reactions to complicated flight conditions. Consequently, it is necessary to impose
high demands of individual psychological, personality and professional quali- ties of cosmonauts to assure the reliability of the cosmonaut-spacecraft system.
We use the term, psychological expertise of cosmonauts, to refer to the set
of psychological examinations at the stages of screening, routine and special certification and special training, which are aimed at finding individuals whose psychological and personality traits make them fit for professional work with specific space equipment.
All of man's distinctions, his psychological productivity, compensatory and reserve capacities are not essentially static; they change, sometimes quite significantly, depending on exogenous and endogenous factors, which leave
a marked impression on the entire personality in a number of cases.
For this reason, the system of psychological expertise, which is an organic element of general clinical expertise, is not limited to regulated certifica- tion of cosmonauts, but includes dynamic psychological monitoring at the training, spaceflight and postflight stages [1, 2].
The teaching on correlation between congenital and acquired qualities, per- sonality traits that form abilities, is the basis of theory of psychological expertise.
Professional capacities are the aggregate of rather stable individual psycho- logical traits of man, although they do change under the influence of rearing, which determines the success of learning a specific work activity on the basis of compensation of some personality traits with others [3].
Since the personality is always characterized by the individual structure of personality traits, the extent of its conformity to the requirements of a given activity determines the professional fitness of an individual.
Soviet psychologists believe that abilities G@ncluding flying) are not inborn; they are formed under the influence of concrete living conditions, upbringing and education of an individual [4, 5]. Only the anatomical and physiological distinctions of organization of the brain and its functions, in particular, the typological properties of the nervous system, are congenital [6, 7]. For this reason, theoretically any physically and mentally healthy person could learn the profession of cosmonaut. However, practice demands consideration of factors of quality, time and economic expediency.
Each new program of spaceflights followed by cosmonauts of the USSR and United States was instrumental in upgrading the system of psychological expertise of cosmonauts.
In the USSR, this system developed from the knowhow in aviation psychology, and the "reproduction" principle was used as its foundation [8]. This was manifested by an original methodological approach, which combined observation with continuous multieffector recording of a number of physiological para- meters and experimental creation of a model situation that reproduces the different aspects of the difficult conditions involved in professional work of cosmonauts. Subsequently, the system of psychological ex :rtise was per- fected in the course of the Vostok, Voskhod and Soyuz missio: [1l, 9-12].
At the present time, expert psychological evaluation of cosmonauts is made by means of a set of psychological and physiological techniques with simulation
of stressogenic spaceflight factors, which permits assessment and forecasting of the cosmonaut's functional and psychological capabilities, as well as his
work capacity as it relates to spaceflight conditions [13-15].
In recent years, personality techniques borrowed from foreign vractice have been used as additional methods (thematic apperception test, Minnesota Multiphasic Inventory, Rosenzweig Picture Frustration Study, Eysenck's, Taylor's questionnaires and others), as well as intelligence tests (Wechsler's Raven's and others). While they have a number of advantages, they are not without substantial flaws, the most important of which is that the present level of technique in interpreting these tests does not provide sufficient reliability of conclusions and complete independence thereof of the experi- menter [16-20].
It is apparent from American sources [21-23, 24] that there are no basic dif- ferences between the systems of psychological expertise in the United States and the USSR. American specialists devote much attention to motivation and social adjustment to the detriment of more objective psychological and physio- logical methods.
Proceeding from the fact that the professional activity of a cosmonaut is,
in its general psychological essence, a process of reception and processing
of incoming information, decision making and handling the system he controls, it is based on the following professionally important psychological properties: capacity for complex differentiating activity of a sensory nature; good operative memory; development of attention properties (volume, concentration, switching, distribution); capacity to retain work capacity in more difficult situations and when time is short; rapid learning and alteration of mental work skill; ability to assess available time and plan one's action accordingly; ability to make a decision when there is a shortage of information; rapid mental processes; good spatial orientation; capacity for rapid and precise thotor reactions; ability to forecast a situation, predict possible changes, ability to distinguish what is important in a flow of information; ability to control’one's actions; intellectual initiative and flexibility; operative [effective] thinking--detection of a problem situation, definition of the problem and finding the means of solving it. Emotional stability is an import- ant trait, as well as temperament features, in which are manifested elements of strength, lability and equilibrium of nervous processes.
More than 20 years of experience with spaceflights makes it possible to single out four main directions of psychological expertise of cosmonauts.
1. Demonstration of adverse individual psychological personality traits that prevent successful learning and performance of professional activity.
2. Obtaining psychophysiological data to define diagnoses when there are some deviations of health status and providing a validated expert decision.
3. Determination of functional psychological capabilities of the individual when exposed to specific factors.
4. Investigation of the effects of real spaceflights on the psychological side of the cosmonaut.
We shall describe below these directions in detail.
1. Adverse individual psychological personality traits for the profession
of cosmonaut are: weakness, inertness, imbalance of nervous processes; scattered and unstable interests and inclinations (particularly those related to cosmonaut activity); indecisiveness, lack of courage; likelihood of dis- ruption when it is necessary to work when time is short and there are inter- ferences; slown and uncritical thinking; instability, exhaustibility of attention; slow attention switching and distribution; slow and inaccurate sensorimotor coordination; diminished memory; difficulty in operating with spatial conceptions; emotional instability; low intelligence.
[t must be borne in mind that the above traits may not only be the individual psychological distinctions of a healthy person, but symptoms of incipient overfatigue or neuropsychological disease. For this reason, the indiyidval psychological distinctions should be assessed with consideration of all
data on development of the personality and dynamic medical supervision.
2. Use of psychologicai examination to pinpoint the diagnosis of certain diseases constitutes an important task of psychological expertise. The demonstrated decline of memory, attention, inhibition of mental processes combined with marked fatigabilivy when performing mental work and low pro- ductivity in given tasks, with slow work pace, may sometimes be the only manifestations of the early stage of cerebrovascular sclerosis [24].
A psychological work-up expands the possibilities of diagnosing long-term sequelae of cerebrocranial trauma and yields data for furnishing a 1: alidated expert decision. It is used as a criterion of res oration of impaired func- tions following relatively recent cerebrocranial trauma. Instances are not uncommon when individuals who have sustained cerebrocranial trauma have residual posttraumatic manifestations that are demonstrable only hy the psychological examination (diminished memory, deviations in higher associa-~ tive processes), together with the results of some functional [load] tests (EKG and neurological examination while breathing with a gas mixture). The obtained data can be used as a criterion of reversibility or, on the contrary, persistence of posttraumatic changes.
A psychological examination may be helpful in differentiating between persis-~- tent pathological mental states and temporary neurotic reactions [25]. In
a number of cases, repeated psychological examinations (occasionally at intervals of 1.5-2 months) permit demonstration of the reactive and, conse- quently, reversible nature of such states.
3. The distinctive feature of the third direction of psychological expertise is that it is performed under natural conditions: various training meets, "survival" experiments with relative social isolation of cosmonauts under difficult climate and geographic conditions (mountain climbing, downhill skiing on steep slopes, prolonged cross-country skiing over rugged terrain
in regions of moderate altitudes, spending many hours in special gear, parachute jumping, etc.) [1]. Being exposed to such situations and active
in them, which is associated with diverse stressogenic and sometimes extreme factors, elicit emotional instability, absent mindedness, loss of mental balance, lack of confidence, disorganization of activity and refusal to continue with it in some people, whereas in others it elicits only insignifi- cant excitement and general working tension, which is instrumental in overcoming the stressogenic situations [26].
The expert psychologist thus has vast opportunities to assess the personality, information about its emotional and conative aspect, reactions, individual psychological traits, psychophysiological reserves of the body, adaptive capabilities, etc. The obtained data make it possibie to define the initial expert decision and formulate a forecast for subsequent stages of training.
Conversation and observation are the principal methods of obtaining information at this stage. In some cases, depending on the problem and distinctions of
the stressogenic situation, a special set of instrument and form [test]
methods is used.
4. Study of the influence of flight conditions and factors, as well as volume and nature of work done,on the main mental functions, personality traits and work capacity of cosmonauts during flights and in the recovery period in order to determine the current work capacity, elaborate recommenda- tions on psychopreventive measures at different stages of the adaptation period and improve the system of psychological expertise.
Determination of level of group interaction in a specific crew at the stage of manning crews and crew training constitutes an independent task for psy- chological expertise; it has been discussed in detail by F. D. Gorbov and M. A. Novikov [27, 28].
The measures used for psychological expertise of cosmonauts must be planned with due consideration of the main principles determining the content and form of such measures.
1. Personality approach, i.e., viewing the cosmonaut's personality and his different mental traits together with activity. According to this principle not a single mental phenomenon manifested by activity can be correctly under- stood without consideration of its personality-related determination. In
the course of psychological expertise, determination and evaluation must be made of socially determined personality traits: orientation of interests, goal orientation, activity with regard *o the candidate's choice of the cosmonaut profession. The content of tis principle refers to the study
of motivation and degree of professiona orientation of the personality.
Altogether, these data are used to implement an important principle of Soviet medical expertise, the principle of individual appraisal, which makes it possible, as an exception, to make a decision as to fitness according to the items in the schedule of diseases that determine unfitness.
2. The complex approach signifies that, in professional expertise of cosmo- nauts, there must be evaluation of fitness of a cosmonaut candidate according to an aggregate of parameters (physical, mental, social and others). In other words, professional expertise must be systemic in nature. The main task for psychological expertise in the aspect of complexity is to study the main mental functions (attention, memory, thinking, emotional stability and work capacity as a whole) under different working conditions and with sim on of psychological factors of flights.
3. Dynamic (stage by stage) expertise refers to a wise or f measures that provide for accumulation of information in the differ: stages of expertise. In view of the fact that some psychological pai seters show some variability under the influence of learning, training, accelerations [or loads], etc., psychological expertise of cosmonauts must be efiecied at
the following times: psychological screening; scheduled [routine] and un- scheduled certification; before assignment to a group for training on a con- crete space program; just prior to a flight.
The scope and form of psychological work-up should change at each stage, depend- ing on the objectives and allocated time.
4. Activity of psychological expertise: One cannot attain a high degree of efficiency of the cosmonaut-spacecraft system solely by means of professional screening and expertise. A set of medicotechnical and ergonomic measures to optimize this system is required, and this implies the need to make use of the findings of psychological examinations not onlyto settle the question of cosmonaut fitness for a special activity, but to adapt equipment to the psy- chological capabilities of a man working in space, for wise automation of a number of regular operations, to refine the training system, to alter the in- formation model of interaction between cosmonauts and space equipment, etc.
5. Differentiated nature of psychological expertise refers to the fact that one should develop and use, as much as possible, the appropriate sets of methods of psychological examination when different groups of cosmonauts
are involved (cosmonaut candidates, candidates for scientist-cosmonauts, cosmonauts, cosmonaut-researchers [scientists]), since the professional activity of different categories of cosmonauts has its own specifics and typical distinctions, which make it necessary to use a differentiated approach to expert decisions. In addition, one has to use a number of methodological ~ procedures that determine general psychological traits required in cosmonauts of all categories.
Development of the above-mentioned directions and principles in the system of psychological expertise of cosmonauts will improve the psychological reliabi- lity of the human element in the cosmonaut-spacecraft system and thereby
be instrumental in successful performance of tasks pertaining to exploration of space.
BIBLIOGRAPHY
1. Gurovskiy, N. N., Myasnikov, V. I., Kozerenko, O. P. et al., in "Kosmicheskiye polety na korablyakh 'Soyuz'" [Spaceflights Aboard Soyuz Series Craft], Moscow, 1976, pp 23-27.
2. LIoseliani, K. K., "Clinical and Psychological Examinations in Medical Flight Expertise," author abstract of doctoral dissertation, Moscow, 1975, p 4.
3. Platonov, K. K., "Psychology of Flying Work," Moscow, 1960, p 234.
4. Leont'yev, A. N., "Problems of Psychological Development," Moscow, 1981.
5. Alyakrinskiy, B. S., in "Aviakosmicheskaya meditsina" [Aerospace Medicine], Moscow, Coll No 1, 1967, pp 221-225.
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Teplov, B. M., VOPR. PSIKHOL., No 5, 1957, pp 108-130.
Nebylitsyn, V. D., "Main Properties of the Nervous System,"' Moscow, 1966. Chaynova, L. D. and Gorbov, F. D., VOPK. PSIKHOL., No 6, 1960, pp 123-130. Gazenko, 0. G., Gurovskiy, N. N., Zayevskiy, R. M. et al., in "Problemy upravleniya funktsiyami oryanizma cheloveka i zhivotnykh" [Problems of
Controlling Human and Animal Functions], Moscow, 1970, p 13.
Gurovskiy, N. N. and Krupina, T. N., KOSMICHESKAYA BIOL., No 6, 1970, pp 3-8.
Myasnikov, V. I. and Novikov, M. A., in "Psikhologicheskiye problemy cheloveka v kosmose" [Psychological Problems of Man in Space], Moscow, 1966, pp 112-119.
Gorbov, F. D., in "Obshchestvo psikhologov SSSR. Vsesoyuznyy s"yezd. 3-y. Materialy" [Proceedings of 3d All-Union Congress of the USSR Society of Psychologists], Moscow, Vol 3, No 1, 1968, pp 115-117. Gorbov, F. D., in "Ergonomika" [Er zonomics], Moscow, No 2, 1971, pp 155-168.
Beregovoy, G. T., Zavalov, N. P., Lomov, B. F. et aJ., "Experimental Psychological Studies it Aviation and Cosmonautics,"’ Moscow, 1978.
Zavalova, N. D. and Ponomarenko, V. A., TEKHN. ESIETIKA, No 7, 1969, pp 7-9. Karvasarskiy, B. D. and Iovlev, B. V., in "Kliniko-psikhologicheskiye issledovaniya lichnosti" [Clinicopsychological Studies of Personality], Leningrad, 1971, pp 43-47.
Anastasi, A., "Differential Psychology," New York, 1965.
Goeters, R. M., AEROKURIER, No 21, 1977, pp 9-10.
Schmale, H. and Schmidtke, K., "Professional Aptitude Test," Stuttgart, 1966.
Wechsler, D., "Measurement of Adult Intelligence," Stuttgart, 1956. Slayton, D. K., AIAA PAPER, No 68-1009, 1968, pp 1-6.
Slayton, D. K., North, W. J. and Woodling, C. H., in "Gemini Midprogram Conference Including Experiment Results," Washington, 1966, pp 201-211.
Fine. P. and Jennings, Sh. F., AEROSPACE MED., Vol 37, 196v, pp 695-701.
Ioseliani, K. K., Parmenov-Trifilov, B. A. et al., in "Psikhologiya i meditsina"” [Psychology and Medicine], Moscow, 1978, pp 377-381.
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loseliani, K. K., KOSMICHESKAYA BIOL., No 1, 1980, pp 68-72. Kuznetsov, 0. N., Ibid, No 3, 1968, pp 62-70.
Gorbov, F. D., Novikov, M. A. et al., “Biological Rhythms and Questions of Working Out Work and Rest Schedules," Moscow, 1967, pp 24-26.
Gorbov, F. D., in "Problemy inzhenernoy psikhologii" [Problems of Engineering Psychology], Leningrad, Vyp 4, 1966, pp 252-260.
UDC: 629.78: [617-089+616-036.882-08-039.72 ANESTHESIA, SURGERY AND RESUSCITATION DURING MANNED SPACEFLIGHTS
Moscow KOSMICHESKAYA BIOLOGIYA I AVIAKOSMICHESKAYA MEDITSINA in Russian Vol 16, No 4, Jul-Aug 82 (manuscript received 15 Apr 81) pp 9-12
[Article by L. L. Stazhadze, I. B. Goncharov, I. P. Neumyvakin, V. V. Bogomolov and I. V. Vladimirov]
[English abstract from source] When exploring the problems of medical aid to be rendered in manned space flights, it is necessary to take into consideration the specific features of the environment as well as the changes in the human body in- duced by space flight effects. In space flight anesthesia can be applied using such advanced methods as multicomponent bal- anced anesthesia and peridural anesthesia. Surgery and resus- citation can be performed, employing the procedures and methods that allow operations in an abacterial environment, correction of vital dysfunctions with the aid of aritficial pulmonary vcuiilation, cardiac electrotherapy, and sorptive purification of body fluids. Various aspects of infusion treatment and first medical aid are discussed.
[Text] Several tasks are advanced pertaining to assuring the safety of manned spaceflights and refinement of the medical aid system in view of expansion
and complication of programs of space research [1-3]. Questions of rendering specialized medical care to crew members with onset of life-endangering
states during a spaceflight are the most difficult to resolve [4-8].
The probability of such states is based on the theoretical possibility of sudden emergency situations, progression or complication of various somatic diseases or functional disorders during the flight period [4, 8, 9-ll]. It may be impossible to return to earth either for technical reasons, or due
to the fact that the patient cannot be transported or tolerate the additional accelerations and inertial impact factors concomitant with the descent phase [5, 10]. Under such conditions, a situation may arise that requires render- ing specialized medical care while in spaceflight.
The specific conditions of spaceflight determine the requirements of both methods and means of medical care. Most of the traditional methods of emergency medicine are not applicable in spaceflight or require appreciable transformation.
When working on problems of medical aid, it is imperative to take into con- sideration the functional deviations in cosmonauts under the influence of spaceflight factors, in addition to their specific habitat [2, 12, 13], which could have a substantial influence on the clinical course of possible dis- eases or other pathological states that are the consequence of extreme factors.
Problems of anesthesiological, surgical and resuscitation aid move to the fore in the presence of emergency and life-threatening states.
Anesthetization may be required during a spaceflight, not only to accompany surgical intervention, but as an element of therapeutic measures when there are pain syndromes of diverse genesis. The series of studies we conducted on volunteers, on the model of antiorthostatic [head tilted down] hypokinesia lasting 7 to 182 days, enabled us to demonstrate the pharmacodynamic distinc- tions of different anesthetics and clinical course of anesthesia as related to reactivity of the body and stage of adaptation to the simulated flight factors [4, 5, 14]. Cardiorespiratory deviations and maximum metabolic changes were noted with the use of anesthetics and other pharmacological agents, the phar- macodynamics of which coincide with the direction of functional deviations that develop in the body with antiorthostatic hypokinesia. The programs and dosage of anesthetics for general anesthesia were optimized on the basis of these studies. An original technique involving multicomponent balanced anesthesia, in which the pharmacological agents are used in subanesthetic dosage, was found to be the most adequate general anesthesia method [4]. It was proven that the general clinical course of anesthesia was controllable, harmless
and corrective.
It is important to note that the use of inhalation anesthetics is inadmissible in the confined and limited space of a spacecraft. Intravenous forms of anesthesia also present technical difficulty, primarily due to the difficulty in reliably separating fluid and gas in the perfusion system. Most of the studied types of general anesthetics, including multicomponent balanced anes- thesia, imply administration of artificial ventilation of the lungs, which
is undesirable, considering the limited number of spacecraft crew members.
Local [regional] anesthesia methods are advanced to one of the main places in the system of anesthesiological aid by the specific conditions of the cos- monauts habitat and activity. In particular, as shown by special experiments and clinical studies, use of auricular acupuncture combined with electro- analgesia according to a method that has been developed produces local anes- thesia in some cases that is sufficient not only to curb the pain syndrome, but for extracavital surgical intervention [5]. Prolonged peridural anes- thesia, which yields satisfactory anesthetization and relaxation, with retention of consciousness, adequate spontaneous respiration and possibility of operator work, whichis particularly important under self-contained condi- tions, is a promising form of regional anesthesia under spaceflight conditions. A technique has been experimentally refined and submitted to clinical trial for long-term peridural anesthesia in individuals with altered reactivity.
Surgery in the event of traumatic injury or acute disease during spaceflights should be undertaken in exceptional cases, when all of the possibilities of
10
conservative therapy have been exhausted. Local hypothermia of the stomach or general external abdominal hypothermia is a rather promising method of conservative therapy for inflammatory diseases of abdominal organs (pan- creatitis, appendicitis) or gastrointestinal hemorrhages.
Theoretically, there may be situations during a manned spaceflight when it
is necessary to have surgical intervention, and this requires development of
a special set of equipment and instruments. It was proven experimentally that it is theoretically possible to perform surgery in weightlessness during flights aboard aircraft in Kepler's parabola. At the same time, the in- creased bacterial contamination of the limited room in a spacecraft, as well as diminished immunoreactivity when man spends a long time in spaceflight [12, 13] make it necessary to search for basically new approaches to solving this problem. Soft surgical abacterial chambers [tents?], made of transparent fluoroplastic [teflon] film with 2-3 pairs of sleeves with surgical gioves built into them are the most promising devices for both minor surgery (wound treatment) and cavitary operations. Use of such chambers rules out contact
of medical personnel with medical supplies, lowers the possibility of infec- tion of the surgical wound. Experimental and clinical studies have confirmed the high effectiveness of this variant of a gnotobiological chamber for surgical interventions.
The rigid requirements of reliability and size-weight characteristics cf medical support equipment in manned spaceflights make it imperative to develop a compact set of surgical instruments, which is achieved by using lightweight alloys and standardized removable parts. The methods and means of sterilizing surgical instruments to assure prolonged storage in sterile condition constitute an independent problem. The properties of dressing and suture materials can be expanded substantially by imparting to them bactericidal and hemostatic features, as well as capacity for resorption in body tissues.
As shown by our studies, in developing the ways and means of resuscitation, one msut take into consideration, first of all, changes in functional state of the cardiovascular system, changes in hydration status, deviations in sympathoadrenal and kallikrein-kinin systems and fluid-electrolyte balance, which arise under the influence of spaceflight factors [9-ll]. In view of the redistribution of fluids in the body under the influence of weightless- ness, in treating life-endangering states of any genesis special attention should be given to prevention, detection and treatment of cerebral edema. An extremely important fact is that, in weightlessness, conditions are created for increased hydration of cerebral structures, which is potentially dangerous for development of swelling and edema of the brain in the event of a life-threatening state. Along with development of various methods of dehydration therapy, including use of osmotic diuretics, one should develop methods of cerebrocranial hypothermia.
Specialized resuscitation provides for correction of critical disturbances
referable to external respiration and cardiac function. Along with develop- ment of methods to correct these disturbances with drugs, one should not
ll
overlook machines for artificial ventilation of the lungs, as well as electro- pulse therapy of cardiac disturbances which are designed for use during spaceflights. The distinction of this equipment from that used in clinical practice is compact execution, self-contained nature, simple operation and
low electric capacity.
It is known that many states (renal, hepatic insufficiency, traumatic injuries, exogenous poisoning) are associated with accumulation of toxic metabolic pro- ducts in blood. Our studies revealed that a rahter effective method for combined therapy of endo- and exo-intoxication is purification of biological fluids (blood, plasma, lymph) through various sorbents. Extensive clinical trials have shown the potential of the method of sorption purification of blood in the presence of various diseases [16, 17].
To introduce this method into space medicine practice, it is imperative to solve several technical and methodological problems. First of all, a universal sorbent with high sorption capacity and mechanical durability must
be developed. The problem of intravenous infusions is very important--it
is not only one of the principal ones in sorption therapy, but in administering anesthesia, perfusions and in surgical interventions.
One solution to this problem is the use of disposable systems filled with drugs or blood substitutes before the flight, on the ground. However, this involves certain difficulties, due to the limited shelf life of some drugs and blood substitutes, as well as the need for a large quantity of disposable units. It is preferable to develop systems and devices that permit reliable separation of fluid from gas in weightlessness. As shown by preliminary studies, this is attained with the use of gas-permeable film or centrifugal separators.
Development of a system of emergency care presents a special problem, when life-threatening states develop during self-contained existence outside an
orbital spacecraft, i.e., in a spacesuit, when engaged in extravehicular
activity or working on another planet. Scientific work in this direction is
based on principles of automation of life-saving measures in accordance with
programs prepared in advance. The triggering mechanism of such factors , should be the programming of the most probable life-endangering disturbances
in cardiac function, respiration and critical disorders referable to vascular
tonus.
Thus, even in this general survey of the problem of emergency medical aid during manned spaceflights, the breadth of scientific research and special technical projects necessary to develop a system of specialized care in emergency situations during manned spaceflights is obvious. At the same time, in spite
of the difficulty of technical solutions of most of the problems mentioned,
the directions of scientific research in this area are distinctly delineated.
BIBLIOGRAPHY
1. Burnazyan, A. I., Vorob'yev, Ye. I., Gazenko, 0. G. et al., KOSMICHESKAYA BIOL., No 5, 1977, pp 312.
12
2. Parin, V. V., Vinogradov, V. M. and Razumeyev, A. N., KOSMICHESKAYA BIOL., No 1, 1969, pp 20-23.
3. Krupina, T. N., Neumyvakin, I. P., Polevoy, L. G. et al., in "Kosmicheskaya biologiya i aviakosmicheskaya meditsina" [Space Biology and Aerospace Medicine], Moscow-Kaluga, Vol 2, 1972, pp 60-62.
4, Stazhadze, L. L., Bogomolov, V. V. and Goncharov, I. B., in "Aviakosmicheskaya meditsina"” [Aerospace Medicine], Moscow-Kaluga, Vol 1, 1979, pp 125-126.
5. Idem, KOSMICHESKAYA BIOL., No 4, 1977, pp 14-16.
6. Neumyvakin, I. P., in "Aviakosmicheskaya meditsina," Moscow-Kaluga, Vol 1, 1979, pp 122-123.
7. LeJeune, F. E. Jr., AVIAT. SPACE ENVIORN. MED., Vol 49, 1978, pp 1347- 1349.
8. Terent'yev, V. G. and Yaroshenko, G. M., KOSMICHESKAYA BIOL., No 2, 1975, pp 83-84.
9. Kovachevich, I. V., "The Sympathoadrenal System and Hemodynamics With Possibility of Development of Traumatic Shock Under the Influence of Simulated Spaceflight Factors on Man," author abstract of candidatorial dissertation, Moscow, 1978.
10. Bogomolov, V. V., Potapov, M. G., Semenova, V. N. et al., in "Aktual'nyye voprosy kosmicheskoy biologii i meditsiny" [Pressing Prob- lems of Space Biology and Medicine], Moscow, Vol 2, 1977, pp 67-69.
ll. Lysak, V. F., in "“Aviakosmicheskaya meditsina,"’ Moscow-Kaluga, Vol l, 1979, pp 126-127.
12. Krupina, T. N., Matsnev, E. I. and Filatova, L. M., in "Kosmicheskaya biologiya i aviakosmicheskaya meditsina," Moscow-Kaluga, Vol 2, 1972, pp 57-59.
13. Konstantinova, I. V., Nefedov, Yu. G., Antonova, Ye. G. et al., in "Aviakosmicheskaya meditsina," Moscow-Kaluga, Vol 1, 1979, pp 118-119.
14. Bogomolov, V. V., Goncharov, I. B. and Semenova, V. N., Ibid, Vol 2, 1975, pp 21-24.
15. Stazhadze, I.. L., Vabishchevich, A. V., Tsibulyak, V. N. et al., KOSMICHE.oKaYA BIOL., No 1, 1981, pp 57-60.
16. Panchenko, R. T., Yarema, I. V. and Urtayev, B. M., ANEST. I REANIMATOL., No 5, 1977, pp 52-55.
17. Lopukhin, Yu. M., Komarov, B. D., Luzhnikov, Ye. A. et al., Ibid, No 2, 1978, pp 81-84.
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EXPERIMENTAL AND GENERAL THEORETICAL RESEARCH UDC: 629.78:612.13 REGIONAL HEMODYNAMIC CHANGES AFTER SPACEFLIGHTS LASTING UP TO EIGHT DAYS
Moscow KOSMICHESKAYA BIOLOGIYA I AVIAKOSMICHESKAYA MEDITSINA in Russian Vol 16, No 4, Jul-Aug 82 (manuscript received 17 Nov 81) pp 12-17 ad
[Article by T. D. Vasil'yeva, Kh. Kh. Yarullin and V. I. Zhuyko]
[English abstract from source] Before and after space missions of up to 8 days in duration 14 cosmonauts were exposed to rheo- graphic examinations to measure the pulse blood filling, tone and elasticity of cerebral vessels (in the frontal-mastoidal and bimastoidal leads), right lung and right leg vessels during
tilt tests. Postflight examinations demonstrated distinct changes in the cerebral, pulmonary and peripheral circulation, thus indicating cardiovascular deconditioning. The greatest changes were seen in the tone of arteries, arterioles and veins of the brain hemispheres, vertebro-basilar system and the leg. The changes were reversible, requiring no special correction.
The changes in different vascular compartments returned to normal in a nonuniform manner: hemodynamic parameters of the lung and leg returned to the preflight level by R+3, whereas those of
the brain by R+tl4.
[Text] It is known that decline of orthostatic stab’ cy (OS) has always been observed in cosmonauts after missions due to deconditoning of the cardiovascular system [1-6]. Several researchers mention, among the causes of diminished OS, deconditioning of the vascular component [3, 6]. For this reason, it was interesting to summarize the results of studies of cosmonauts’ regional hemodynamics during orthostatic tests (OT), as well as changes in parameters of vessels of different regions occurring as a result of space- flights and to trace the dynamics of recovery thereof.
Methods
We conducted a rheographic study of blood filling, tonus and elasticity of cerebral vessels (in frontomastoid and bimastoid leads), right lung and right lower leg during OT in 14 cosmonauts before and after spaceflights lasting
up to 8 days. OT were performed once before the flight, and after the flight--on the day they landed, 3d and 14th days. OT consisted of having the cosmonauts stand passively on a turntable at an angle of 70° for 10 min. The
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rheogram was recorded on a bipolar 4 RG 1M rheograph using an 8-channel elec- trocncephalograph, and this was done before the test, with the subjects in horizontal position, then in the lst, 3d, 5th, 7th, 9th min in vertical position and lst, 3d 5th min of horizontal position.
We studied the following parameters: maximum amplitude of rheographic wave (A) in ohms, which reflects pulsed filling of vessels of the region examined; ratio of duration of anacrotic phase of rheogram to duration of cardiac cycle (a/T), as a percentage reflecting mainly the tonus and elasticity of
large and medium caliber arteries; ratio of height of incisura to maximum amplitude of rheogram--dicrotic index (DCI) and ratio of dicrotic elevatio” to maximum amplitude--diastolic index (DSI), reflecting arteriolar and venous tonus, respectively. All of the obtained data were submitted to statistical processing.
Results and Discussion Endurance of OT before the flight was rated as good in all cosmonauts.
Before the flight, in the lst min of vertical position, the subject presented
a 25% decrease (p<0.05) in pulsed filling of the right hemisphere, which gradu- ally increased from the 3d min on, but still was 15% lower than the background value in the 9th min. When the cosmonaut was moved to horizontal position, pulsed filling increased, exceeding the base value by 13% in the lst min in this position. Thereafter, this parameter gradually declined to the background level (Figure la).
In the OT done 4-6 h after landing (Q day), the changes in pulsed filling of the right hemisphere with the cosmonaut in vertical position were analogovu :; however, when he changed to horizontal position it increased more drastical’v than before the flight, exceeding the base level by 34% (p<0.01). There was development of moderate reactive cerebral hyperemia, which had been negligible before the flight.
On the 3d postlanding day, with the OT there was more marked decline, by 382, in pulsed filling of the right hemisphere than on 0 day (p<0.05). On the 14th day, we demonstrated even greater decline in pulsed filling during the test, and it reached 43% (p<0.05). In the OT before the flight a/T of the right hemisphere decreased by 34% (p<0.05). During the recovery period in horizontal position, it fncreased appreciably and was 12% greater than the pretest level (Figure 1b). On 0 day, a/T both at rest before the test and in erect position exceeded significantly the preflight values (p<0.05). On the 3d postflight day, &/T was above the preflight value only with the subjects in horizontal position before and after OT, and during the test the absolute values and dynamics thereof did not differ from preflight findings.
REG DCI of the hemisphere during the preflight OT decreased by 25% (p<0.01) in the lst min, remaining on this level thereafter, to the end of the test (Figure lc). On the day of landing REG DCI during the OT diminished more significantly--by 37% (p<0.001). This parameter recovered faster, within the first min tn horizontal position. DCI dynamics did not differ reliably from preflight findings on the 3d and 14th postflight days.
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Figure l. Changes in pulsed filling (a), tonus of arteries with large and medium caliber (b), dicrotic index (c) and diastolic index (d) of the right hemisphere during orthostatic test Here and in Figures 2-4: 1) preflight 2) landing day 3) 3d postflight day 4) 14th postflight day X-axis, time of test (min); y-axis, values of parameters
Figure 2. Changes in hemodynamic parameters of vertebrobasilar system during OT
Preflight DSI during the first min of the OT (Figure 1d) decreased by 22% (p<0.01), gradually declining (by 25%; p<0.01) by the 9th min. On O day, the dynamics of DSI during the OT did not differ from preflight findings; however, both during the test and in the recovery period, the mean values of parameters of venous tonus were 15% lower than preflight. Venous tonus of the right hemisphere increased on the 3d and 14th postflight days, and</