Nitrous oxide mitigation, look before you leap

Chakera, A; Pearson, Fiona

doi:10.1111/anae.15862

Cited by 10 publications

(16 citation statements)

References 1 publication

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“…As most nitrous oxide is lost from central piping systems before the point of use, these systems can be decommissioned [22] and replaced with portable cylinders [23]. In high-use areas such as maternity, a manifold supply may remain necessary, and optimising manifold efficiency by fixing leaks, auditing consumption and locating manifolds closer to the end user can improve efficiency [24]. Capture and cracking of exhaled nitrous oxide can reduce emissions following patient use [25].…”

Section: Obstetric Anaesthesiamentioning

confidence: 99%

Anaesthetic subspecialties and sustainable healthcare: a narrative review

Oliver,

Charlesworth,

Pratt

et al. 2024

Anaesthesia

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SummaryThe principles of environmentally sustainable healthcare as applied to anaesthesia and peri‐operative care are well documented. Associated recommendations focus on generic principles that can be applied to all areas of practice. These include reducing the use of inhalational anaesthetic agents and carbon dioxide equivalent emissions of modern peri‐operative care. However, four areas of practice have specific patient, surgical and anaesthetic factors that present barriers to the implementation of some of these principles, namely: neuroanaesthesia; obstetric; paediatric; and cardiac anaesthesia. This narrative review describes these factors and synthesises the available evidence to highlight areas of sustainable practice clinicians can address today, as well as posing several unanswered questions for the future. In neuroanaesthesia, improvements can be made by undertaking awake surgery, moving towards more reusables and embracing telemedicine in quaternary services. Obstetric anaesthesia continues to present questions regarding how services can move away from nitrous oxide use or limit its release to the environment. The focus for paediatric anaesthesia is addressing the barriers to total intravenous and regional anaesthesia. For cardiac anaesthesia, a significant emphasis is determining how to focus the substantial resources required on those who will benefit from cardiac interventions, rather than universal implementation. Whilst the landscape of evidence‐based sustainable practice is evolving, there remains an urgent need for further original evidence in healthcare sustainability targeting these four clinical areas.

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Section: Obstetric Anaesthesiamentioning

confidence: 99%

Anaesthetic subspecialties and sustainable healthcare: a narrative review

Oliver,

Charlesworth,

Pratt

et al. 2024

Anaesthesia

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“…Multiple recent studies have demonstrated a considerable N 2 O gap, attributed to residual N 2 O left in depleted cylinders, leakage from pipelines and manifolds, overprovision, poor stock management and other causes. 37,67,68,73 An example is the significant discrepancy of 39,600 L N 2 O unaccounted for from the monthly purchase of 186,600 L at Sunshine Hospital, Melbourne. 37…”

Section: The N2o Gapmentioning

confidence: 99%

“…Many reports indicate that N 2 O loss via delivery infrastructure like pipelines and manifolds in hospitals is a major contributor to the N 2 O gap. 42,66–69,73 In 2019, pipeline system losses of anesthetic N 2 O contributed 1582 t CO 2 e of the total 4559 t CO 2 e, within NHS Lothian. In NHS Scotland, the carbon emissions attributed to manifold loss of N 2 O were 9385 t CO 2 e. 73 In Australia, evaluation of the N 2 O delivery systems at Footscray Hospital, Melbourne, demonstrated a 160,000 L per year discrepancy between procurement and clinical usage (after accounting for depleted cylinders), which was 77% of the total N 2 O procurement.…”

Section: The N2o Gapmentioning

confidence: 99%

Nitrous Oxide Use in Australian Health Care: Strategies to Reduce the Climate Impact

Liu

Lee-Archer

Sheridan

et al. 2023

Anesthesia &Amp; Analgesia

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Nitrous oxide is a useful inhaled analgesic. Due to its high global warming potential and ozone-depleting properties, the nitrous oxide emissions related to health care are being increasingly scrutinized. In this narrative review, we will discuss the clinical uses of nitrous oxide relevant to anesthetists, in addition to its contribution as a greenhouse gas. Using available data from Australia, we will explore potential strategies for reducing the impact of those emissions, which are likely to be applicable in other countries. These include destruction of captured nitrous oxide, minimizing nitrous oxide waste and reducing clinical use. Anesthesia clinicians are well placed to raise awareness with colleagues and consumers regarding the environmental impact of nitrous oxide and to promote cleaner alternatives. Reducing use is likely to be the most promising reduction strategy without large-scale changes to infrastructure and subsequent delay in action.

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“…Several studies have demonstrated that the volume of nitrous oxide purchased can considerably exceed what is used clinically. Research from Scotland revealed that wastage within piped nitrous oxide systems is a more significant problem than clinical usage [16]. Even a microleak of 1 liter per minute can lead to a loss of 43,000 liters a month, or 516,000 liters a year.…”

Section: Desflurane and Nitrous Oxidementioning

confidence: 99%