SCUBA diving at technical depths exposes divers to toxic effects of compressed air, specifically from N2 – this is nitrogen narcosis. It is a reversible condition when making a proper ascent, but has no current underwater treatment aside from depth and gas mixture precautions. After evaluating existing evidence, this work proposes that taking an oral lipid emulsifier, immediately prior to SCUBA diving, can prevent symptoms associated with nitrogen narcosis. Databases such as Google Scholar and PubMed were utilized to search for appropriate articles. From this, 21 papers were ultimately categorized as the most relevant, given the following parameters – SCUBA diving, nitrogen narcosis, LAST, lipid emulsion therapy, and GABA receptor. Factors such as recency and strength of provided evidence were ultimately used to rank the papers, along with exclusion criteria of general anesthesia. This review aims to evaluate existing mechanistic and preclinical evidence to support the hypothesis that LE can reduce nitrogen narcosis in divers. As such, this work is presented as a hypothesis-generating review, and the included studies were summarized using a narrative synthesis. When hyperbaric nitrogen reaches lipid-rich neural tissue, it binds to hydrophobic pockets on the GABA-A receptor – leading to impaired cognition and decreased neuromuscular function. Current literature suggests the use of lipid resuscitation for LAST may also be applied as treatment for the associated CNS toxicity of nitrogen narcosis. This is highlighted through proposed targeting of hyperbaric N2 by the multimodal mechanism of LE therapy. Studies have been performed on mice in hyperbaric chambers, but it is still unknown if results translate to humans under hyperbaric conditions. This proposed therapy can potentially reduce risk for divers who descend to technical depths. Ethical issues surrounding testing serve as a limitation, and further research is needed to assess the safety and efficacy of such therapy in mitigating nitrogen narcosis symptoms.
