ALBERT

Description: Intramuscular promethazine and its efficacy in the treatment of Space Motion Sickness (SMS) were evaluated using standardized questions administered during postflight debriefings to crewmembers immediately after their first Shuttle flight. The comparison showed that 25 percent of crewmembers treated with IM promethazine were 'sick' on flight day 2, compared to 50 percent of crewmembers who did not receive promethazine, 90 percent reported immediate symptom relief as well. Untreated crewmembers typically have slow symptom resolution over 72-96 h, and those treated with oral scopolamine/dextroamphetamine show delayed symptom development. This study suggests that intramuscular promethazine is an effective treatment for SMS and merits continued use and further controlled investigations.

Description: Hydrazine (HZ) and monomethyl hydrazine (MMH) are highly toxic compounds used as fuels in the Space Shuttle Orbiter Main Engines and in its maneuvering and reaction control system. Satellite refueling during a mission may also result in release of hydrazines. During extravehicular activities, the potential exists for hydrazines to contaminate the suit and to be brought into the internal atmosphere inadvertantly. Because of the high toxicity of hydrazines, a very sensitive, reliable, interference-free, and real-time method of measurement is required. A portable ion mobility spectrometer (IMS) has exhibited a low ppb detection limit for hydrazines suggesting a promising technology for the detection of hydrazines in spacecraft air. The Hydrazine Monitor is a modified airborne vapor monitor (AVM) with a custom-built datalogger. This off-the-shelf IMS was developed for the detection of chemical warfare agents on the battlefield. After early evaluations of the AVM for hydrazine measurements showed a serious interference from ammonia, the AVM was modified to measure HZ and MMH in the ppb concentration range without interference from ammonia in the low ppm range. A description of the Hydrazine Monitor and how it functions is presented.

Description: Space motion sickness (SMS) has been a problem affecting approximately 74 percent of first time shuttle flyers. Promethazine injections have been used for 29 cases of SMS to decrease the severity of their illness. Although reported to be effective in reducing symptoms in 27 of the 29 cases, there has been no proof of its efficacy. Methods: Retrospective analysis of medical debriefs examining the symptom scores for nausea, vomiting, decreased appetite, and stomach awareness were performed. Each symptom is rated on a mild = 1, moderate = 2, severe = 3 system for each flight day. Crewmember scores for the first three flight days on an initial flight in which injectable promethazine had not been used were compared to scores in a later flight in which the promethazine was utilized. Scores were also compared in a similar group of crewmembers who did not use promethazine. Results: There was a decrease in median scores for all symptoms except nausea, however, it was significant (p = 0.14) only for the vomiting scores. This significant decrease was not seen in the control group. Conclusions: Injectable promethazine has been associated with a significant decrease in vomiting compared to earlier flights in which injectable promethazine was not used.

Description: Flight surgeons routinely monitor crew symptoms and treatment of space motion sickness (SMS), not only during flight, but also to obtain information postflight from each crewmember. Recent statistics indicate that the incidence of SMS has not changed since STS-26 in Sep. 1988. The percentages of mild, moderate, and severe cases has only changed slightly. However, the treatment of SMS has significantly changed since STS-26. Scopolamine/dexedrine is no longer used as a prophylaxis for SMS symptoms because of evidence of delay in symptoms. Intramuscular promethazine has been used in more than 30 individuals with a reported decrease in symptoms greater than 90 percent. A delay in symptoms has not been reported, and the duration of certain SMS symptoms has decreased due to use of intramuscular promethazine. Case studies will be discussed and several therapeutic options and doses will be demonstrated. Further treatment possibilities will be examined.

Description: Until Mar. 1989, no effective treatment--either prophylactic or symptomatic--for space motion sickness (SMS) had been discovered. Since Mar. 1989, intramuscular (IM) promethazine (PMZ) has been used in the treatment of SMS with extremely favorably results reported by the crew. A retrospective study was undertaken to quantify the efficacy of IM PMZ since its institution and the incidence of its major anticipated side-effect drowsiness and sedation. The results from a standardized crew medical debriefing conducted immediately after landing and follow-up interviews with the crews were used in establishing the efficacy and incidence of side effects from treatment. Only crews from the first 44 Shuttle flights on their first mission were considered. For a total of 132 crewmembers, 96 exhibited symptoms of SMS; and, of these, 20 were treated with IM PMZ. Ninety percent of those receiving IM PMZ 25-50mg received nearly immediate (less than 2 hours) relief of symptoms and 75 percent required no further treatment through the first 2 days of spaceflight. Those not receiving this treatment did not have any near-term resolution of their symptoms, and 50 percent were still ill through the second day of flight. This represents a significant difference at the p = 0.46 level. In stark contrast to the 60 percent to 73 percent incidence of sedation or drowsiness reported in individuals treated with PMZ in terrestrial environment at the doses used here, less than 5 percent reported these symptoms during spaceflight. IM PMZ is an effective therapy for SMS and is associated with minimal incidence of sedation or drowsiness. This combination of efficacy that is absent of significant side effects represents a substantial improvement in the operational situation of crewmembers afflicted with SMS. Studies to understand the mechanisms underlying these observations will be undertaken in the future.

Description: Treatment strategies for space motion sickness were compared using the results of postflight oral debriefings. Standardized questionnaires were administered to all crewmembers immediately following Space Shuttle flights by NASA flight surgeons. Cases of space motion sickness were graded as mild, moderate, or severe based on published criteria, and medication effectiveness was judged based on subjective reports of symptom relief. Since October 1989, medication effectiveness is reported inflight through private medical conferences with the crew. A symptom matrix was analyzed for nineteen crewmembers treated with an oral combination of scopolomine and dextroamphetamine (scopdex) and fifteen crewmembers treated with promethazine delivered by intramuscular or suppository routes. Scopdex has been given preflight as prophylaxis for space motion sickness but analysis showed delayed symptom presentation in nine crewmembers or failed to prevent symptoms in seven.