Clearing the Air: Nitrous Oxide in Australian Paediatric Practice

Nitrous oxide is a commonly used anaesthetic gas, particularly in paediatric practice; however there are growing concerns about its environmental impact as both a greenhouse gas and ozone-depleting substance. Whilst the nitrous oxide emissions related to healthcare are small compared to other industries, the majority of the nitrous oxide purchased by the healthcare sector is attributed to non-clinical purposes such as leaks from central supply systems. This review aims to contextualise the provision, use, and processing of nitrous oxide in Australian paediatric practice, understand issues associated with its use, and consider whether the clinical utility of nitrous oxide outweighs its environmental impact.

This review specifically addresses the breadth of paediatric practice including non-anaesthesia use through consideration of pre-existing primary and secondary research and specialist input from paediatric emergency, anaesthesia, and dental experts.

Key findings include the need to measure the nitrous oxide 'gap' to determine emissions targets, strategies to facilitate the transition from centralised pipeline systems, and a consideration of alternative approaches throughout and beyond the nitrous lifecycle.

Ultimately, modifications to nitrous oxide supply, efficient clinical use, and viable alternatives to nitrous oxide where appropriate will be necessary to continue providing responsible, sustainable healthcare.