The use of nitrous oxide ‘cracking’ technology in the labour ward: a case report and patient account

Abstract

Nitrous oxide is a common choice of labour analgesia in many countries. However, its use is associated with significant cost to the environment as well as potential risks of long-term occupational exposure. Our hospital is one of a small number of healthcare providers in the United Kingdom trialling technology which catalytically destroys (`cracks´) nitrous oxide to reduce greenhouse gas emissions and occupational exposure. When used in the setting of inhaled analgesia, cracking technology relies on capturing the patient's exhaled breath via a facemask or mouthpiece, a technique which requires some user skill and may be challenging for patients. In this report, we present the case of a primiparous 35-year-old consultant anaesthetist, who used nitrous oxide cracking technology with inhaled nitrous oxide analgesia (via a facemask) during labour. We present the patient's experiences and discuss the implications of using such technology on ambient nitrous oxide levels in the delivery room. Notably, despite this patient's professional expertise and familiarity with facemask use, nitrous oxide remained detectable throughout her labour, although generally at low levels. This illustrates that whilst this technology has the potential to reduce ambient nitrous oxide levels, its efficacy may vary depending on how it is used, with implications for patient education and support.

Driving down the carbon cost of peri‐operative care: old controversies, new topics, fresh perspectives and the future

“…Chakera et al report their experiences of the Nitrous Oxide Project, addressing medical gas management at a local, regional and national level in the NHS [10]. The losses of agent to the atmosphere from piped systems and manifolds in hospitals are staggering, and this group has shown real change through reduced overall purchases of medicinal nitrous oxide in the UK and in supporting organisations to decommission central delivery systems [11]. With wastage so high, more widespread decommissioning in developed healthcare systems seems to be the next low-hanging fruit in sustainable peri-operative care.…”

“…Yet there is an important ethical argument regarding providing appropriate analgesia to women in labour, where nitrous oxide continues to have an important role. Thankfully, Chakera et al provide solutions [10], and cracking technologies may also play a future role to reduce emissions still further [11].…”

“…Thankfully, Chakera et al. provide solutions [10], and cracking technologies may also play a future role to reduce emissions still further [11].…”

Case reports, reflective practice and learning to succeed

“…When cases go well, we should look to see what elements existed that lead to a successful outcome, so that they can be repeated. Reporting cases where a novel technique is used with success can allow us to reflect on this [21][22][23]. It is important that we model ourselves on excellence as much as we try to evolve from error.…”

‘Cracking’ the environmental problem of nitrous oxide in obstetrics

“…Addressing these obstacles early would be necessary for the longer‐term success of a nitrous scavenging and destruction system. A first‐hand account of patient's experience of the technology describes the experience as ‘very positive’ and patient buy‐in is clearly key to successful implementation [19].…”