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Chapter 37 — 5
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Strong analgesics.
Preparations containing codeine or dextropropoxyphene (both narcotic derivatives) and other
strong analgesics are sometimes prescribed for severe pain.
These drugs have comparable sedative effects to the tranquillisers and can have similar adverse
interactions with diving. People with pain of this intensity should not be diving.
Insulin and Anti–diabetic Agents
People taking these drugs are prone to sudden depression of the blood sugar level which
produces
anxiety
,
confusion
and then
unconsciousness
. This is particularly likely during
exercise. This complication in the water often has a fatal outcome. Because of this possibility
and other potential physiological complications (e.g. acidosis and hyperventilation), diabetics
are generally advised against diving.
Bronchodilators and other
Asthma Medications
Asthma is an inflammatory condition of the air passages of the lungs. It causes swelling of the
lining of the airways, spasm of the muscles in the airways (bronchospasm) and obstruction of
airflow through them. The bronchospasm can be reduced by aerosol sprays containing drugs
such as salbutamol ("Ventolin") or oral bronchodilators. These can disturb cardiac rhythm and
precipitate the sudden death syndrome during diving, because of the multiple trigger factors
(see Chapter 35).
While the use of these and other asthma medications will improve some of the airway flow and
thus relieve symptoms, it does not cure the condition. Asthmatics have airways which are
excessively sensitive to irritants, reacting with bronchospasm to stimuli such as cold dry air and
sea water inhalation. There is usually a degree of obstruction in some of the airways most of the
time. This makes them susceptible to pulmonary barotrauma or death from the diving sequelae
of asthma - panic and drowning.
Some oral bronchodilators (theophylines) can cause pulmonary vasodilatation – which could
potentially allow asymptomatic venous bubbles from normally safe dives to enter the arterial
circulation as gas emboli, even without pulmonary barotrauma.
Asthma and these medications
are incompatible with safe diving.
Implanted Drug Delivery Systems
Implanted
reservoirs
are now being used to deliver drugs which cannot be taken orally and
which need to be used over prolonged periods. Many of the conditions for which these
reservoirs are used are incompatible with scuba diving.
Implants form a potential site of bubble formation during decompression. If bubbles form inside
or around the reservoir, expansion in response to the gas laws may lead to excessive delivery of
the drug. As experience with these devices in diving is limited, divers fitted with them are
advised to seek expert medical advice concerning the possible complications.