[TML] Low Berths

[Robert]

Jerry Barrington wrote:
> All your comments following this seem to be derived from the body
> temperature problem...

The muscle rigidity, flatline EEG, etc. are cooling related. Even if you 
maintained core body temperature you'd be left with no muscle power and an 
almost-flat EEG. Metabolic rate has been reduced by a factor of 60, after 
all.

One other exciting consequence of fast drug use is 'death by shaving cut'. 
If the coagulation system is slower by a factor of sixty, you should be able 
to exsanguinate someone through an otherwise trivial laceration, despite the 
[similar-size] reduction in cardiac output.

> Never heard of blankets & heating pads?!?

I have heard of them, actually. They don't work very well at all.
When I manage hypothermics (accidental, or deliberate induction for clinical 
purposes) I do it properly with temperature, respiratory and haemodynamic 
monitoring, warmed IV fluids, convective heating devices and finally 
cardiopulmonary bypass, if things are really bad.

That's an easy scenario. Someone who has become brain stem dead and has no 
hypothalamic
function at all - the nearest real world physiological analog to the fast 
drug user, at least from the temperature control perspective - is somewhat 
more challenging, especially if they have started to get cold. It's hard to 
recover lost ground in that situation.

The sort of hardware mentioned above is what you will need to maintain your 
fast drug 'steering class' passengers if you want any shot at a reasonable 
survival rate. This is in addition to the usual monitoring - which really 
gets you back to a low berth level of [intensive] care for induction, 
maintenance and emergence - or higher - anyway.

As Leonard wrote, maintaining normothermia essentially guarantees rot. The 
subject's immune system is also slowed by a factor of sixty, so it can't do 
diddly against commensal or other bacteria.

If fast drug can fix this problem, then it's a universal antibiotic, as I 
mentioned earlier. Slow a pathogen down so a host's immune system can mop it 
up.

> Which has all the same problems of using it for travel.

Emergency use in a life and death situation vs. a travel aid. Unless you're 
fleeing certain death at the hands of an oppressive regime/your friendly 
loan shark/whatever, I don't think the situations are at all equivalent 
ethically or clinically.

The risk-benefit calculation seems a bit skewed. I did say 'legitimate 
clinical use'.

Mark Urbin wrote:
> Ahhh...like the drug "Hiberzine" in John Ringo's Legacy of the Aldenata
> books.

Yep. To be used only by, or on the authority of, a licensed physician, under 
well defined circumstances.

Douglas E Knapp wrote:
> Many on these problems are not problem depending on what is meant by
> "slower metabolism"

Decreased metabolic rate. What else would it mean?

> For this "drug" to be real it would really need to be many drugs put 
> together.

Lots of them.

> Who knows what each one does?
<snip>
> Can you really say what would be the side effects of this drug without 
> knowing
> what it is doing and to what pathways?

What are the subjects of physiology and pharmacology about?
We have been told it reduces metabolic rate by a factor of sixty.
Apply this change to each organ system.
The list of effects will contain several of the items previously posted, 
among others. The effects of the attendant immobility will lead to other 
items on the previously posted list, etc.

Given the enlarged problem list, we then need to come up with 
countermeasures. Some will not be pharmaceutical, but external hardware 
(temperature control system, etc.)
We will then know what the 'fast drug' (drug regime) needs to do to get the 
desired effect

> Is this a hibernation drug? Many mammals can do this well.

The physiology of hibernation is very interesting, e.g.
http://research.uleth.ca/rgs/hib_physiol.cfm

Cooling to five degree celsius implies a staggering drop in metabolic rate. 
Cycling in and out of
torpor episodes is an impressive feat in its own right.

Unfortunately only a few primates have the ability to hibernate.
Human enzyme systems don't work very well outside a fairly narrow range of 
temperature and pH.

Jerry Barrington, again:
> And hibernation may well be latent in all mammals...
>
<http://www.fhcrc.org/about/ne/news/2005/04/21/roth.html>

The article in 'Science' by Roth et al was also very interesting. Haven't 
heard much about this since, sadly.

Controlled administration of hydrogen sulfide, carbon monoxide, etc.(or some 
other substance with a very narrow safety margin/therapeutic index) to 
induce and maintain suspension is going to be somewhat more difficult than 
"dose 'em up and chuck 'em in the hold!" if you want to do it well.

>From the article linked above:
"In the end I suspect there will be clinical benefits and it will change the 
way medicine is practiced, because we will, in short, be able to buy 
patients time."

This fits nicely with my previous remarks about fast drug's clinical use.


Robert O'Connor
medico, gamer