Mitigating the systemic loss of nitrous oxide: a narrative review and data-driven practice analysis

Area of Science:

• Environmental Science
• Healthcare Sustainability
• Anesthesiology

Background:

• Climate change poses significant health risks, necessitating environmental responsibility in clinical practices.
• Inhaled anesthetics like nitrous oxide (N2O) are potent greenhouse gases with long atmospheric lifetimes and high global warming potential.
• Central N2O supply systems in healthcare facilities are a major, often overlooked, source of unnecessary greenhouse gas emissions.

Purpose of the Study:

• To review the environmental impact of N2O in healthcare settings.
• To present N2O utilization data from 47 US hospitals.
• To provide guidance for clinicians to mitigate N2O emissions.

Main Methods:

• Analysis of N2O utilization data from two large US healthcare systems.
• Review of existing literature on N2O environmental impact and mitigation strategies.
• Case study illustrating the impact of transitioning from central to portable N2O supply systems.

Main Results:

• Significant non-clinical N2O losses (47.2-99.8%) were identified in US healthcare systems, consistent with UK and Australian findings.
• Transitioning from central to portable N2O supply systems reduced N2O consumption by 97.6% in one quaternary medical center.
• This mitigation strategy has been successfully adopted by over 25 hospitals.

Conclusions:

• Central N2O supply systems represent a substantial and under-recognized source of greenhouse gas emissions in healthcare.
• Switching to portable N2O supply systems is a highly effective strategy for reducing N2O consumption and environmental impact.
• Clinicians are empowered to lead facility-level initiatives for decarbonization and improved environmental stewardship in healthcare.