The ability to provide anaesthesia will be important given the expected risk of severe medical events requiring surgery. Knowledge and experience of such procedures during space missions is currently extremely limited. Future space exploration missions will take humans far beyond low Earth orbit and require complete crew autonomy. Austere and isolated environments have been used extensively as test beds for spaceflight to probe hazards and countermeasures for prospective space missions.

Significant plans have been drawn by government space agencies and private companies for manned spaceflights beyond low Earth orbit (LEO) in the coming years, with a focus on missions to Mars. Such flights have been termed space exploration missions (SEM). The latest National Aeronautics and Space Administration (NASA) mission design called for a 900-day mission for a crew of 6, with around 6 months spent in transit, each way, and 500 days on the Mars surface.

While the analysis of space analogue environments is important given the restricted access to space, no substitute can fully replicate the uniqueness of a future SEM, where a self-reliant restricted crew will be exposed to exceptional challenges and risks, some of which are impossible to foresee. Space analogues are only simulations of greater or lesser fidelity along varying dimensions of interest.

While this review provides useful clues regarding some critical aspects of anaesthesia in space, several factors remained unexplored and warrant further research. More research needs to be done to define the ultimate skillset of the astronaut physician, design tools to prevent skills erosion during the flight and address the question of skills redundancy.

Many considerations beyond the specific illness or injury will influence the outcome, including environmental factors, communications, supplies, crew preparation, skills redundancy and teamwork. Preparation for the management of surgical conditions is only in its infancy, but safe and efficient anaesthesia could theoretically be achievable.

Future spaceflight medical systems must permit a well-trained medical officer to autonomously provide care for the crew during the mission.