Inert gas narcosis in scuba diving, different gases different reactions.

PURPOSE: Underwater divers face several potential neurological hazards when breathing compressed gas mixtures including nitrogen narcosis which can impact diver's safety. Various human studies have clearly demonstrated brain impairment due to nitrogen narcosis in divers at 4 ATA using critical flicker fusion frequency (CFFF) as a cortical performance indicator. However, recently some authors have proposed a probable adaptive phenomenon during repetitive exposure to high nitrogen pressure in rats, where they found a reversal effect on dopamine release. METHODS: Sixty experienced divers breathing Air, Trimix or Heliox, were studied during an open water dive to a depth of 6 ATA with a square profile testing CFFF measurement before (T0), during the dive upon arriving at the bottom (6 ATA) (T1), 20 min of bottom time (T2), and at 5 m (1.5 ATA) (T3). RESULTS: CFFF results showed a slight increase in alertness and arousal during the deep dive regardless of the gas mixture breathed. The percent change in CFFF values at T1 and T2 differed among the three groups being lower in the air group than in the other groups. All CFFF values returned to basal values 5 min before the final ascent at 5 m (T3), but the Trimix measurements were still slightly better than those at T0. CONCLUSIONS: Our results highlight that nitrogen and oxygen alone and in combination can produce neuronal excitability or depression in a dose-related response.

Do Environmental Conditions Contribute to Narcosis Onset and Symptom Severity?

Although many factors contributing to inert gas narcosis onset and severity have been put forward, the available evidence is not particularly strong. Using objective criteria, we have assessed brain impairment associated with narcosis under various environmental diving conditions. 40 volunteers performed a no-decompression dive (33 m for 20 min) either in a dry chamber, a pool or open sea. They were assessed by critical flicker fusion frequency before the dive, upon arriving at depth, 5 min before ascent, on surfacing and 30 min post-dive. Compared to the pre-dive value, the mean value of each measurement was significantly different. An increase of flicker fusion to 105.00±0.69% when arriving at depth is followed by a decrease to 94.05±0.65%. This impairment persists when surfacing and 30 min post-dive, decreasing further to 96.36±0.73% and 96.24±0.73%, respectively. Intragroup comparison failed to demonstrate any statistical difference. When objectively measured narcosis may not be influenced by external factors other than pressure and gas. This might be of importance for training to avoid any over- or underestimation of the severity of narcosis based only on subjective symptoms.

Assessment of the interaction of hyperbaric N2, CO2, and O2 on psychomotor performance in divers.

Diving narcosis results from the complex interaction of gases, activities, and environmental conditions. We hypothesized that these interactions could be separated into their component parts. Where previous studies have tested single cognitive tasks sequentially, we varied inspired partial pressures of CO2, N2, and O2 in immersed, exercising subjects while assessing multitasking performance with the Multi-Attribute Task Battery II (MATB-II) flight simulator. Cognitive performance was tested under 20 conditions of gas partial pressure and exercise in 42 male subjects meeting U.S. Navy age and fitness profiles. Inspired nitrogen (N2) and oxygen (O2) partial pressures were 0, 4.5, and 5.6 ATA and 0.21, 1.0, and 1.22 ATA, respectively, at rest and during 100-W immersed exercise with and without 0.075-ATA CO2 Linear regression modeled the association of gas partial pressure with task performance while controlling for exercise, hypercapnic ventilatory response, dive training, video game frequency, and age. Subjects served as their own controls. Impairment of memory, attention, and planning, but not motor tasks, was associated with N2 partial pressures >4.5 ATA. Sea level O2 at 0.925 ATA partially rescued motor and memory reaction time impaired by 0.075-ATA CO2; however, at hyperbaric pressures an unexpectedly strong interaction between CO2, N2, and exercise caused incapacitating narcosis with amnesia, which was augmented by O2 Perception of narcosis was not correlated with actual scores. The relative contributions of factors associated with diving narcosis will be useful to predict the effects of gas mixtures and exercise conditions on the cognitive performance of divers. The O2 effects are consistent with O2 narcosis or enhanced O2 toxicity.

Age-related effects of increased ambient pressure on discrimination reaction time: A study in 105 professional divers at 6.0 atm abs.

We investigated 105 professional divers using a computerized visual discrimination trial (Cognitrone) to measure the effects of ambient pressure on reaction times. The possible improvement in performance due to practice was anticipated, and the trials were carried out four times prior to pressurization in a hyperbaric chamber. The effect of increased ambient pressure was measured at 6.0 and 1.9 atm abs, and the potential for residual effects was tested after decompression. The results of our study indicate that repeated testing had a systematic influence on the measured time values. The effects of learning, which were independent of diver age, may have independently influenced response times. Exposure to 6.0 atm abs modified the systematic pattern of learning and was associated with increased reaction times. There were also age-related differences in response times associated with exposure to increased ambient pressures. Younger divers were more susceptible to elevated ambient pressure, evidenced by increased response times at 6 atm abs relative to their older colleagues. One out of every four of the younger divers could be considered susceptible to inert gas narcosis (ION) when an increase of one standard deviation/1SD (> 19%) or more in discrimination reaction time is used as an indicator. ION susceptibility appears independent of body composition and physical fitness. The slowed response speed experienced at 6.0 atm abs was of short duration and returned to baseline immediately with decompression. Our results suggest that IGN is demonstrated by an impaired learning process and decreased response speed and that some younger divers appear more susceptible.

Inert gas narcosis disrupts encoding but not retrieval of long term memory.

Exposure to increased ambient pressure causes inert gas narcosis of which one symptom is long-term memory (LTM) impairment. Narcosis is posited to impair LTM by disrupting information encoding, retrieval (self-guided search), or both. The effect of narcosis on the encoding and retrieval of LTM was investigated by testing the effect of learning-recall pressure and levels of processing (LoP) on the free-recall of word lists in divers underwater. All participants (n=60) took part in four conditions in which words were learnt and then recalled at either low pressure (1.4-1.9atm/4-9msw) or high pressure (4.4-5.0atm/34-40msw), as manipulated by changes in depth underwater: low-low (LL), low-high(LH), high-high (HH), and high-low (HL). In addition, participants were assigned to either a deep or shallow processing condition, using LoP methodology. Free-recall memory ability was significantly impaired only when words were initially learned at high pressure (HH & HL conditions). When words were learned at low pressure and then recalled at low pressure (LL condition) or high pressure (LH condition) free-recall was not impaired. Although numerically superior in several conditions, deeper processing failed to significantly improve free-recall ability in any of the learning-recall conditions. This pattern of results support the hypothesis that narcosis disrupts encoding of information into LTM, while retrieval appears to be unaffected. These findings are discussed in relation to similar effects reported by some memory impairing drugs and the practical implications for workers in pressurised environments.

Impairment from gas narcosis when breathing air and enriched air nitrox underwater.

BACKGROUND: Nitrogen (N2) in air causes cognitive impairment from gas narcosis when breathed at increased ambient pressures. This impairment might be reduced by using enriched air nitrox (EANx) mixtures, which have a higher oxygen and lower N2 content compared to air. This study aimed to investigate if divers differed in memory ability and self-assessment when breathing air and EANx30. METHODS: The effect of depth (shallow vs. deep) and breathing gas (air vs. EANx30) on memory ability and subjective ratings of impairment was compared in 20 divers. RESULTS: Memory performance was significantly worse in deep water (Air: M = 22.1%, SD = 21.7%; EANx30: M = 22.1%, SD = 17.2%) compared to shallow water (Air: M = 29.2%, SD = 18.3%; EANx30: M = 33.3%, SD = 18.2%), but this impairment did not differ significantly between air and EANx30. Subjective ratings of impairment increased significantly from shallow water (Air: M = 5.2, SD = 5.9; EANx30: M = 3.0, SD = 4.4) to deep water (Air: M = 36.8, SD = 25.3; EANx30: M = 24.8, SD = 16.1) when breathing both air and EANx30. However, ratings were significantly lower when breathing EANx30 compared to air when in the deep water. DISCUSSION: It was concluded EANx30 does not reduce narcotic impairment over air. Additionally, divers were able to make a correct global self-assessment they were impaired by narcosis, but were unable to make a finer assessment, leading them to erroneously believe that EANx30 was less narcotic than air.

Memory and metacognition in dangerous situations: investigating cognitive impairment from gas narcosis in undersea divers.

OBJECTIVE: The current study tested whether undersea divers are able to accurately judge their level of memory impairment from inert gas narcosis. BACKGROUND: Inert gas narcosis causes a number of cognitive impairments, including a decrement in memory ability. Undersea divers may be unable to accurately judge their level of impairment, affecting safety and work performance. METHOD: In two underwater field experiments, performance decrements on tests of memory at 33 to 42 m were compared with self-ratings of impairment and resolution. The effect of depth (shallow [I-II m] vs. deep [33-42 m]) was measured on free-recall (Experiment I; n = 41) and cued-recall (Experiment 2; n = 39) performance, a visual-analogue self-assessment rating of narcotic impairment, and the accuracy of judgements-of-learning JOLs). RESULTS: Both free- and cued-recall were significantly reduced in deep, compared to shallow, conditions. This decrement was accompanied by an increase in self-assessed impairment. In contrast, resolution (based on JOLs) remained unaffected by depth. The dissociation of memory accuracy and resolution, coupled with a shift in a self-assessment of impairment, indicated that divers were able to accurately judge their decrease in memory performance at depth. CONCLUSION: These findings suggest that impaired self-assessment and resolution may not actually be a symptom of narcosis in the depth range of 33 to 42 m underwater and that the divers in this study were better equipped to manage narcosis than prior literature suggested. The results are discussed in relation to implications for diver safety and work performance.

Complex tactile performance in low visibility: the effect of nitrogen narcosis.

BACKGROUND: In a task-environment where visibility has deteriorated, individuals rely heavily on tactile performance (perception and manipulation) to complete complex tasks. When this happens under hyperbaric conditions, factors like nitrogen narcosis could influence a person's ability to successfully complete such tasks. OBJECTIVE: To examine the effect of nitrogen narcosis on a complex neuropsychological task measuring tactile performance at a pressure of 608 kPa (6 atm abs), in the absence of visual access to the task. METHODS: In a prospective cross-over study, 139 commercial divers were tested in a dry chamber at 101.3 kPa and 608 kPa. They completed the Tupperware Neuropsychological Task (TNT) of tactile performance without visual access to the task, and completed questionnaires to provide psychological and biographical data, which included trait anxiety and transient mood states, as well as formal qualifications and technical proficiency. RESULTS: A significant decrement (9.5%, P < 0.001) in performance on the TNT at depth was found, irrespective of the sequence of testing. Generally, neither the psychological nor biographical variables showed any significant effect on tactile performance. Tactile performance on the surface was a good indicator of performance at depth. CONCLUSION: These findings have practical implications for professional diving where conditions of low visibility during deeper diving occur. Recommendations are made towards managing potential impairments in tactile performance, such as pre-dive practical learning ('rehearsal') as an aid to successful completion of tasks.

Effects of hyperbaric nitrogen-induced narcosis on response-selection processes.

Certain underwater circumstances carry risk of inert gas narcosis. Impairment of sensorimotor information processing due to narcosis, induced by normobaric nitrous oxide or high partial nitrogen pressure, has been broadly evidenced, by a lengthening of the reaction time (RT). However, the locus of this effect remains a matter of debate. We examined whether inert gas narcosis affects the response-selection stage of sensorimotor information processing. We compared an air normobaric condition with a hyperbaric condition in which 10 subjects were subjected to 6 absolute atmospheres of 8.33% O2 Nitrox. In both conditions, subjects performed a between-hand choice-RT task in which we explicitly manipulated the stimulus-response association rule. The effect of this manipulation (which is supposed to affect response-selection processes) was modified by inert gas narcosis. It is concluded, therefore, that response selection processes are among the loci involved in the effect of inert gas narcosis on information processing.

Nitrogen narcosis and tactile shape memory in low visibility.

OBJECTIVE: Commercial diving often occurs in low visibility, where divers are reliant on their tactile senses. This study examined the effect of nitrogen narcosis on tactile memory for shapes as well as the influence of psychological and biographical factors on this relationship. METHOD: This crossover study tested 139 commercial divers in a dry hyperbaric chamber at 101.325 and 607.95 kPa (1 and 6 atmospheres absolute/atm abs). Divers memorized shapes while blindfolded, using their tactile senses only. Delayed recall was measured at the surface after each dive. Psychological and biographical data were also collected. RESULTS: A significant effect of hyperbaric pressure on tactile memory was demonstrated, and a further effect of sequence of testing found. Thus, divers' delayed shape recall deteriorated by 8% after learning material at depth, compared to learning on the surface. There were also significant but small effects of psychological and biographical markers on tactile memory performance, with lower trait anxiety associated with better recall, and lower education associated with poorer recall. CONCLUSION: The findings emphasize the importance of utilizing other forms of recording of events or objects at depth, particularly in conditions of low visibility during deeper diving, to aid memory encoding and subsequent recall at the surface.

Functional comparison between critical flicker fusion frequency and simple cognitive tests in subjects breathing air or oxygen in normobaria.

INTRODUCTION: Measurement of inert gas narcosis and its degree is difficult during operational circumstances, hence the need for a reliable, reproducible and adaptable tool. Although being an indirect measure of brain function, if reliable, critical flicker fusion frequency (CFFF) could address this need and be used for longitudinal studies on cortical arousal in humans. METHODS: To test the reliability of this method, the comparison between CFFF and three tests (Math-Processing Task, Trail-Making Task, and Perceptual Vigilance Task) from the Psychology Experiment Building Language battery (PEBL) were used to evaluate the effect of 10 minutes of 100% normobaric oxygen breathing on mental performance in 20 healthy male volunteers. RESULTS: Breathing normobaric oxygen significantly improved all but one of the measured parameters, with an increase of CFFF (117.3 ± 10.04% of baseline, P < 0.0001) and a significant reduction of time to complete in both the math-processing (2,103 ± 432.1 ms to 1,879 ± 417.5 ms, P = 0.0091) and trail-making tasks (1,992 ± 715.3 to 1,524 ± 527.8 ms, P = 0.0241). The magnitude of CFFF change and time to completion of both tests were inversely correlated (Pearson r = -0.9695 and -0.8731 respectively, P < 0.0001). The perceptual vigilance task did not show a difference between air and O2 (P > 0.4). CONCLUSIONS: The CFFF test provides an assessment of cognitive function that is similar to some tests from PEBL, but requires a less complicated set up and could be used under various environmental conditions including diving. Further research is needed to assess the combined effects of increased pressure and variations in inspired gas mixtures during diving.

Inert gas narcosis and the encoding and retrieval of long-term memory.

BACKGROUND: Prior research has indicated that inert gas narcosis (IGN) causes decrements in free recall memory performance and that these result from disruption of either encoding or self-guided search in the retrieval process. In a recent study we provided evidence, using a Levels of Processing approach, for the hypothesis that IGN affects the encoding of new information. The current study sought to replicate these results with an improved methodology. METHODS: The effect of ambient pressure (111.5-212.8 kPa/1-11 msw vs. 456-516.8 kPa/35-41 msw) and level of processing (shallow vs. deep) on free recall memory performance was measured in 34 divers in the context of an underwater field experiment. RESULTS: Free recall was significantly worse at high ambient pressure compared to low ambient pressure in the deep processing condition (low pressure: M = 5.6; SD = 2.7; high pressure: M = 3.3; SD = 1.4), but not in the shallow processing condition (low pressure: M = 3.9; SD = 1.7; high pressure: M = 3.1; SD = 1.8), indicating IGN impaired memory ability in the deep processing condition. In the shallow water, deep processing improved recall over shallow processing but, significantly, this effect was eliminated in the deep water. DISCUSSION: In contrast to our earlier study this supported the hypothesis that IGN affects the self-guided search of information and not encoding. It is suggested that IGN may affect both encoding and self-guided search and further research is recommended.

Does inert gas narcosis have an influence on perception of pain?

The effect of an increased nitrogen partial pressure under hyperbaric conditions is known as nitrogen narcosis (NN). At an ambient pressure of about 4 bar, reduced cognitive performance as well as euphoric effects are reported. We examined the effect of NN on pain perception. 22 subjects completed an experimental (50 meters = 6 bar) and a simulated control dive (0 m = 1 bar) in a hyperbaric chamber. Before and during each dive a standardized cold pressure test was performed. The intensity of pain perceived was assessed with the help of a visual analogue scale; additionally, subjects assessed the subjective effect of NN. The study showed that the perceived pain intensity is significantly reduced under nitrogen narcosis conditions (F1.21 = 5.167, p < 0.034) when compared to the perceived pain intensity under the control dive conditions (F1.21 = 0.836, p = 0.371). A connection between perceived pain intensity and subjects experience of the NN was not found under the experimental dive condition (r = 0.287, p = 0.195). We could show that even relatively moderate hyperbaric conditions may have an influence on the perception of pain. The results are highly relevant since nitrogen narcosis occurs in divers as well as in medical personnel or construction workers, working under hyperbaric conditions.

Measuring manual dexterity and anxiety in divers using a novel task at 35-41 m.

BACKGROUND: Nitrogen narcosis has a detrimental impact on the manual dexterity of divers and prior research has suggested that this impairment may be magnified by anxiety. Preliminary findings of the effects of depth (i.e., narcosis) and subjective anxiety on a novel test of manual dexterity are presented. METHODS: There were 45 subjects who were given a test of manual dexterity once in shallow water (1-10 m/3-33 ft) and once in deep water (35-41 m/115-135 ft). Subjective anxiety was concurrently measured in 33 subjects who were split into 'non-anxious' and 'anxious' groups for each depth condition. RESULTS: Subjects took significantly longer (seconds) to complete the manual dexterity task in the deep (mean = 52.8; SD = 12.1) water compared to the shallow water (mean = 46.9; SD = 8.4). In addition, anxious subjects took significantly longer to complete the task in the deep water (mean = 48.6; SD = 6.8) compared to non-anxious subjects (mean = 53.2; SD = 9.9), but this was not the case in the shallow water. DISCUSSION: This selective effect of anxiety in deep water was taken as evidence that anxiety may magnify narcotic impairments underwater. It was concluded that the test of manual dexterity was sensitive to the effects of depth and will be a useful tool in future research.

Inert gas narcosis has no influence on thermo-tactile sensation.

Contribution of skin thermal sensors under inert gas narcosis to the raising hypothermia is not known. Such information is vital for understanding the impact of narcosis on behavioural thermoregulation, diver safety and judgment of thermal (dis)comfort in the hyperbaric environment. So this study aimed at establishing the effects of normoxic concentration of 30% nitrous oxide (N(2)O) on thermo-tactile threshold sensation by studying 16 subjects [eight females and eight males; eight sensitive (S) and eight non-sensitive (NS) to N(2)O]. Their mean (SD) age was 22.1 (1.8) years, weight 72.8 (15.3) kg, height 1.75 (0.10) m and body mass index 23.8 (3.8) kg m(-2). Quantitative thermo-tactile sensory testing was performed on forearm, upper arm and thigh under two experimental conditions: breathing air (air trial) and breathing normoxic mixture of 30% N(2)O (N(2)O trial) in the mixed sequence. Difference in thermo-tactile sensitivity thresholds between two groups of subjects in two experimental conditions was analysed by 3-way mixed-model analysis of covariance. There were no statistically significant differences in thermo-tactile thresholds either between the Air and N(2)O trials, or between S and NS groups, or between females and males, or with respect to body mass index. Some clinically insignificant lowering of thermo-tactile thresholds occurred only for warm thermo-tactile thresholds on upper arm and thigh. The results indicated that normoxic mixture of 30% N(2)O had no influence on thermo-tactile sensation in normothermia.

Psychomotor function during mild narcosis induced by subanesthetic level of nitrous oxide: individual susceptibility beyond gender effect.

OBJECTIVE: We investigated the effect of narcosis induced by subanesthetic concentrations of nitrous oxide (N2O), a behavioral analogue for hyperbaric nitrogen, on psychomotor performance. In particular, we assessed individual susceptibility to narcosis. METHODS: The participants were 12 female and 12 male undergraduate students. Psychomotor assessment was conducted with a computerized Visual Simple Reaction Time (VSRT) test, and Trail Making Tests Part A (TMTA) and Part B (TMT-B). The tests were conducted on two separate occasions in the following order: VSRT, TMT-A, TMT-B. On the first occasion participants conducted the tests breathing room air (air trial), and during the second test they conducted the tests while breathing a normoxic mixture containing 30% N2O (N2O trial). RESULTS: Males had significantly (p = 0.036) shorter VSRT in the air trials. There was no effect of gender on psychomotor performance in the N2O trials. Overall, mean performance in the N2O trials degraded significantly (p = 0.004) only in VSRT. Performance of individual participants exhibited different and inconsistent direction of change in the N2O trials. CONCLUSION: N2O-induced alterations in psychomotor function are primarily dependent on individual susceptibility to narcosis (i.e., concentration threshold).

A review of recent neurochemical data on inert gas narcosis.

Nitrogen narcosis occurs in humans at around 0.4 MPa (4 ATA). Hydrogen narcosis occurs between 2.6 and 3.0 MPa. In rats, nitrogen disturbances occur from 1 MPa and a loss of righting reflex around 4 MPa. Neurochemical studies in striatum of rats with nitrogen at 3 MPa (75% of anesthesia threshold) with differential pulse voltammetry have demonstrated a decrease in dopamine (DA) release by neurons originated from the substantia nigra pars compacta (SNc). Such a decrease is found also with compressed argon, which is more narcotic than nitrogen and with the anesthetic gas nitrous oxide. Inversely, compressed helium with its very low narcotic potency induces DA increase. Microdialysis studies in the striatum have indicated that nitrogen also induces a decrease of glutamate concentration. Nitrogen pressure did not modify NMDA glutamate receptor activities in SNc or striatum but enhanced GABAA receptors activities in SNc. Repetitive exposures to nitrogen narcosis suppressed the DA decrease and induced an increase. This fact and the lack of improvement of motor disturbances did not support the hypothesis of a physiological adaptation. The desensitization of the GABAA receptors on DA cells during recurrent exposures and the parallel long-lasting decrease of glutamate coupled to the increase in NMDA receptor sensitivity suggest a nitrogen neurotoxicity or addiction induced by recurrent exposures. The differential changes produced by inert gases indifferent neurotransmitter receptors would support the binding protein theory.

Anxiety and psychomotor performance in divers on the surface and underwater at 40 m.

INTRODUCTION: Performance impairments attributed to the effects of nitrogen narcosis have been reported to be significantly larger in studies conducted underwater compared to in hyperbaric chambers. One suggestion is that the larger impairment results from higher levels of anxiety in the underwater environment. The current study aimed to investigate the impact of anxiety and narcosis, in isolation and in combination, on a measure of psychomotor performance. METHODS: The effects of self-reported anxiety (anxious vs. not anxious) and depth (surface vs. underwater) on performance on the digit letter substitution test (DLST) were measured in 125 divers. RESULTS: Change from baseline scores indicated that divers performed significantly worse on the DLST underwater (mean = 3.35; SD = 4.2) compared to the surface (mean = 0.45-0.73; SD = 4.0-4.2). This decrement was increased when divers reported they were also anxious (mean = 7.11; SD = 6.1). There was no difference on DLST performance at the surface between divers reporting they were anxious and those reporting they were not anxious. DISCUSSION: The greater decrement in performance at depth in divers reporting anxiety compared to those not reporting anxiety and the lack of this effect on the surface suggested that anxiety may magnify performance deficits presumed to be caused by narcosis.

The feasibility of pharmacological mitigation of nitrogen narcosis during submarine escapes from depths down to 1,000 fsw.

INTRODUCTION: Nitrogen (N2) narcosis could interfere with deep submarine escapes, particularly in the escape trunk, where simple but essential tasks are required in order to leave the submarine and start rapid ascent. In a previous study, we had suggested that prolongation of lungs-to-brain circulation time (LBct) may have a protective effect on N2 narcosis, a hypothesis tested in the present study. MATERIALS AND METHODS: Computer software was designed to assess the effects of changes in circulation times on N2 uptake and distribution during the extremely rapid pressure changes typical of submarine escapes. Simulations of escapes from 600 to 1,000 fsw (with 200-fsw steps) were performed, with varying dwell times (DT) in the escape trunk (from 10 to 60 seconds, in 10-second steps). Baseline cardiac output (CO) was set at 5 liters/minute, and it was varied through changes in heart rate from 50% to 200% in the escape simulations. LBct was assumed to vary inversely with CO. RESULTS: The risk of N2 narcosis was expressed as equivalent narcosis depth (END) in fsw, corresponding to N2 pressure in the brain after five minutes of air diving at that equivalent depth. The effects of changing CO on the highest END values (corresponding to the peak N2 pressures) reached while in the escape trunk or during entire escapes were tabulated. Depths at which peak N2 occurred were also analyzed. Prolonging LBct appeared to have two advantageous effects: 1. It reduced peak N2 reached both in the escape trunk and during the entire course of the escape 2. It delayed peak N2 to later stages of escapes (i.e., closer to the surface during ascent). These effects were more evident at greater escape depths and with longer DTs. CONCLUSIONS: Prolongation of LBct could protect against N2 narcosis and it could plausibly be achieved with the oral administration of a beta-blocker, such as propranolol, prior to deep submarine escape. Animal experiments should be conducted to validate this pharmacological approach.