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Blood alcohol concentrations above defined levels are detrimental to cognitive performance. Empirical and published evidence suggest that nitrogen narcosis is analogous to alcohol intoxication with both impairing prefrontal cortex function. Nitrogen narcosis is also known to have been a factor in fatal accidents. To examine the effects of nitrogen narcosis, a recent publication used the Iowa Gambling Task tool, to simulate dynamic real-life risky decision-making behaviour. If the reported outcomes are corroborated in larger rigorously designed studies it is likely to provide further evidence that divers may well experience the negative effects of a 'narcotic agent', even at relatively shallow depths. These deleterious effects may occur regardless of diving experience, aptitude or professional status. In 1872, English law made it an offence to be 'drunk' whilst in charge of horses, carriages, cattle and steam engines. Understanding the danger was easy, establishing who is 'drunk' in the eyes of the court required a legal definition. Driving above a 'legal limit' for alcohol was made illegal in the United Kingdom in 1967. The limit was set at 80 milligrams of alcohol per 100 millilitres of blood. It took just short of one hundred years to get from first introducing a restriction to specific activities, whilst under the influence of alcohol, to having a clear and well-defined enforceable law. The question surely is whether our modern society will tolerate another century before legally defining safe parameters for nitrogen narcosis? [ABSTRACT FROM AUTHOR]

Introduction: Critical flicker fusion frequency (CFFF) has been used in various studies to measure the cognitive effects of gas mixtures at depth, sometimes with conflicting or apparently paradoxical results. This study aimed to evaluate a novel automatic CFFF method and investigate whether CFFF can be used to monitor gas-induced narcosis in divers. Methods: Three hyperbaric chamber experiments were performed: 1) Automated and manual CFFF measurements during air breathing at 608 kPa (n = 16 subjects); 2) Manual CFFF measurements during air and heliox breathing at sea level (101.3 kPa) and 608 kPa (n = 12); 3) Manual CFFF measurements during oxygen breathing at sea level, 142 and 284 kPa (n = 10). All results were compared to breathing air at sea level. Results: Only breathing oxygen at sea level, and at 284 kPa, caused a significant decrease in CFFF (2.5% and 2.6% respectively compared to breathing air at sea level. None of the other conditions showed a difference with sea level air breathing. Conclusions: CFFF did not significantly change in our experiments when breathing air at 608 kPa compared to air breathing at sea level pressure using both devices. Based on our results CFFF does not seem to be a sensitive tool for measuring gas narcosis in divers in our laboratory setting. [ABSTRACT FROM AUTHOR]

Introduction: Gas narcosis impairs divers when diving deeper. Pupillometry is sensitive to alcohol intoxication and it has been used in anaesthesia to assess nitrous oxide narcosis. It is a potential novel method to quantify narcosis in diving. The aim of this study was to evaluate pupillometry for objective measurement of narcosis during exposure to hyperbaric air or nitrous oxide. Method: Pupil size in 16 subjects was recorded directly at surface pressure and during air breathing at 608 kPa (equivalent to 50 metres’ seawater depth) in a hyperbaric chamber. Another 12 subjects were exposed to nitrous oxide at end-tidal percentages of 20, 30 and 40% in random order at surface pressure. Pupil size and pupil light reflex were recorded at baseline and at each level of nitrous oxide exposure. Results: Pupil size did not significantly change during exposure to hyperbaric air or nitrous oxide. The pupil light reflex, evaluated using percentage constriction and minimum diameter after exposure to a light stimulus, was affected significantly only during the highest nitrous oxide exposure – an end-tidal level of 40%. Conclusion: Pupillometry is insensitive to the narcotic effect of air at 608 kPa in the dry hyperbaric environment and to the effects of low dose nitrous oxide. Pupillometry is not suitable as a monitoring method for gas narcosis in diving. [ABSTRACT FROM AUTHOR]

Introduction: When humans breathe compressed air or N2-O2 mixtures at three to four atmospheres pressure, they will experience nitrogen narcosis that may possibly lead to a diving accident, but the underlying mechanisms remain unclear. Methods: Mice were exposed to 1.6 MPa breathing a N2-O2 mixture adjusted to deliver an inspired PO2 of 32-42 kPa. The electroencephalogram (EEG) and forced swimming test were used to evaluate the narcotic effect of nitrogen. Neuronal activity was observed via c-Fos expression in cortex and hippocampus tissue after decompressing to the surface. To further investigate underlying molecular mechanisms, we incubated cultured hippocampal neurons with various NMDA concentrations, and measured expression of NMDA receptors and its down-stream signal with or without 1.6 MPa N2-O2 exposure. Results: Both the frequency of the EEG and the drowning time using the forced swimming test were significantly decreased during exposure to 1.6 MPa N2-O2 (P < 0.001). Additionally, in cultured hippocampal neurons, the increased levels of phosphorylated NR2B and cAMP-response element binding protein (CREB) induced by NMDA stimulation were significantly inhibited by exposure to 1.6 MPa N2-O2. Conclusions: Our findings indicated that NR2B-containing NMDA receptors were inhibited during nitrogen narcosis. [ABSTRACT FROM AUTHOR]

Introduction: Cognitive impairment related to inert gas narcosis (IGN) is a threat to diving safety and operations at depth that might be reduced by using enriched air nitrox (EANx) mixtures. Using critical flicker fusion frequency (CFFF), a possible early detection of cognitive abilities/cerebral arousal impairment when breathing different oxygen (O2) fractions was investigated. Methods: Eight male volunteers performed, in random order, two dry chamber dives breathing either air or EANx40 (40% O2-60% nitrogen) for 20 minutes (min) at 0.4 MPa. Cognition and arousal were assessed before the dive; upon arrival at 0.4 MPa; after 15 min exposure at 0.4 MPa; on surfacing and 30 min post-dive using behavioural computer-based testing psychology experiment building language (PEBL) and by CFFF while continuously recording brain oxygenation with near-infrared spectroscopy. Results: In both breathing conditions, CFFF and PEBL demonstrated a significant inverse correlation (Pearson r of -0.90, P < 0.0001), improved cognitive abilities/cerebral arousal occurred upon arrival at 0.4 MPa followed by a progressive deterioration. Initial brain activation was associated with a significant increase in oxyhaemoglobin (HbO2) and a simultaneous decrease of deoxyhaemoglobin (HHb). The magnitude of the changes was significantly greater under EANx (P = 0.038). Conclusions: Since changes were not related to haemodynamic variables, HbO2 and HHb values indicate a significant, O2-dependent activation in the prefrontal cortex. Owing to the correlation with some tests from the PEBL, CFFF could be a convenient measure of cognitive performance/ability in extreme environments, likely under the direct influence of oxygen partial pressure, a potent modulator of IGN symptoms. [ABSTRACT FROM AUTHOR]

Introduction: Inert gas narcosis (IGN) impairs cognitive performance and some divers are more susceptible to IGN than others. We compared the sensitivity of two reaction time tests to detect changes in performance at pressure and compared these results with critical flicker fusion frequency (CFF) changes at the same ambient pressures. Methods: The study assessed simple reaction time (RT), mean time correct of the discrimination reaction time (MTC) and CFF in 30 professional divers breathing air at 101 kPa and 608 kPa in a hyperbaric chamber. Results: RT and MTC increased at 608 kPa by 5.1 ± 9.4% (P = 0.04) and 7.3 ± 12.3% (P = 0.01) respectively. RT decreased to pre-compression level after decompression and MTC decreased to a level lower than pre-compression (P < 0.001) values. CFF increased by 2.5 ± 2.8% (P < 0.001) at 608 kPa. CFF decreased to pre-compression level after decompression. An increase in CFF was inversely correlated with a decrease in RT (r = 0.38, P = 0.04) and in MTC (r = 0.43, P = 0.02) at 608 kPa. Conclusions: Response speeds of the same subjects were impaired in both reaction time tasks at 608 kPa, whereas CFF increased at depth. An association between changes in response times and changes in CFF suggests that divers susceptible to IGN may also be susceptible to the effects of elevated oxygen partial pressure. If this holds true, the future selection of professional divers could be improved by the use of simple cognitive tests. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Technical divers use gases other than air and advanced equipment configurations to conduct dives that are deeper and/or longer than typical recreational air dives. The use of oxygen--nitrogen (nitrox) mixes with oxygen fractions higher than air results in longer no-decompression limits for shallow diving, and faster decompression from deeper dives. For depths beyond the air-diving range, technical divers mix helium, a light non-narcotic gas, with nitrogen and oxygen to produce 'trimix'. These blends are tailored to the depth of intended use with a fraction of oxygen calculated to produce an inspired oxygen partial pressure unlikely to cause cerebral oxygen toxicity and a nitrogen fraction calculated to produce a tolerable degree of nitrogen narcosis. A typical deep technical dive will involve the use of trimix at the target depth with changes to gases containing more oxygen and less inert gas during the decompression. Open-circuit scuba may be used to carry and utilise such gases, but this is very wasteful of expensive helium. There is increasing use of closed-circuit 'rebreather' devices. These recycle expired gas and potentially limit gas consumption to a small amount of inert gas to maintain the volume of the breathing circuit during descent and the amount of oxygen metabolised by the diver. This paper reviews the basic approach to planning and execution of dives using these methods to better inform physicians of the physical demands and risks. [ABSTRACT FROM AUTHOR]

The article discusses a study which investigates divers' perception of fatigue and critical flicker fusion frequency (CFFF) after breathing air and enriched air nitrox (EANx). EANx is composed of 32% nitrogen and 68% nitrogen. Results of the study showed that in comparison with pre-dive, there is a 6% decrease in CFFF in the air group and a 4% increase in the EANx group. A nitrogen effect, a bubble effect and an oxygen effect are the three hypotheses that could explain the difference in perceived fatigue in post-dive and alertness between the two groups.

The article presents a study on the phenomena of gaseous anaesthesia and inert gas narcosis. The study examined the similarities of the two phenomena including the possibility that they are classifications of the same fundamental process. Current biochemical evidence that connotes that the conformational change and biological action abilities of the two phenomena are hindered by the occupation of minute spaces in biologically vital proteins was used. It is concluded that inert gases have physiological effects.

A continuing professional development (CPD) test related to inert gas narcosis and gaseous anaesthesia is presented.