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A Novel Inhalation Mask System to Deliver High Concentrations of Nitric Oxide Gas in Spontaneously Breathing Subjects

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Reducing Nitrous Oxide Emissions Across the Melbourne Biomedical Precinct.

Ross Robertson¹, Andrew Downey², Daryl Williams^3,4

¹Department of Anaesthesia, Perioperative Medicine and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.

The Medical Journal of Australia

|July 5, 2026

Summary

Australian hospitals are reducing nitrous oxide (N2O) emissions, a major source of greenhouse gases from anesthetic gas leaks. Strategies include decommissioning piped N2O systems and exploring alternatives, showcasing diverse approaches to environmental sustainability in healthcare.

Keywords:

anaesthesia anaesthesia, obstetrical anaesthesia, paediatric climate change global warming

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Published on: December 20, 2016

Area of Science:

Environmental Science
Healthcare Sustainability
Anesthesiology

Background:

Nitrous oxide (N2O) is a significant contributor to greenhouse gas emissions in Australian healthcare, primarily from leaks in reticulated anesthetic gas systems.
Recent Australasian guidelines no longer mandate the use of a reticulated N2O supply, creating opportunities for emission reduction.

Purpose of the Study:

To document and analyze the strategies employed by four Melbourne hospitals to decrease N2O emissions.
To highlight the diverse clinical contexts and challenges encountered in reducing anesthetic gas-related greenhouse gas emissions.

Main Methods:

Case study analysis of four hospitals implementing N2O emission reduction strategies.
Two hospitals decommissioned reticulated N2O systems, transitioning to cylinder supplies based on clinical consultation and interdisciplinary collaboration.
Two hospitals with high N2O demand and shared infrastructure are conducting audits and trials to inform changes.

Main Results:

Successful decommissioning of reticulated N2O systems in two hospitals, demonstrating a viable pathway to emission reduction.
Ongoing efforts in two other hospitals facing challenges with high clinical demand and complex infrastructure.
Case studies illustrate varied approaches and obstacles in mitigating N2O emissions.

Conclusions:

Hospitals can effectively reduce nitrous oxide emissions through strategic changes in anesthetic gas supply.
Interdisciplinary collaboration and clinical consultation are crucial for successful transitions away from reticulated N2O systems.
Diverse strategies are necessary to address the varied clinical demands and infrastructural complexities in emission reduction efforts.