Complete removal of nitrous oxide from the operating room

Abstract

Study objective: To assess the use of nitrous oxide as an anesthetic gas in the operating room and assess the environmental impacts for the site-specific case mix.

Design: The study focused on providing educational sessions to anesthesia staff at one academic medical center. The study assessed the usage of nitrous oxide E-cylinders and central supply in the operating room, which includes up to 46 anesthetizing locations, as part of the quality improvement initiative.

Setting: Operating Room.

Patients: No patient data or patients were included in the study.

Interventions: Educational sessions, in the form of grand rounds and guest speakers, highlighted the environmental impact of anesthetic agents.

Measurements: Operational data was used to quantify the usage of nitrous oxide. Emissions factors were used to calculate the avoided carbon dioxide equivalent emissions through discontinuation of nitrous oxide in 46 anesthetizing locations.

Main results: Survey assessment of current usage and needs of nitrous oxide fostered staff engagement and promoted a collaborative approach to evaluating its discontinuation. Assessment showed that the availability of E-cylinders and central supply were not required in the anesthetizing locations and removal reduced emissions.

Conclusions: Engaging anesthesia providers in discussion about the environmental impacts of anesthetic agents is critical in increasing awareness of healthcare's contribution to climate change. The study focused on nitrous oxide, surveying anesthesia providers to assess current usage patterns and anticipated future needs. The institution successfully eliminated E-cylinders and discontinued central supply of nitrous oxide from the sites. With targeted engagement and institutional support, complete removal of nitrous oxide from anesthesia practice is feasible and impactful.

Keywords: Anesthetic agents; Climate change; Greenhouse gas emissions; Nitrous oxide; Operating room.