MEDICAL GASES AND ANAESTHESIA
The Copenhagen hospital tackling nitrous oxide issue
The Maternity Unit at Copenhagen’s Hvidovre Hospital has recently reintroduced nitrous oxide to support women in labour pain, having ceased using it a decade ago due to concerns over potential health risks to staff. Denmark has since, however, developed new safety protocols for N2
effective analgesic, the hospital wanted to reintroduce it, but needed to address its substantial climate footprint. Jannik Jensen, Global Product manager at Medclair, and his colleague, R&D manager, Olesya Nikonova, explain how a Medclair central nitrous oxide destruction system met the brief.
Nitrous oxide (N2 O) gas was first
synthesised in 1772 by English natural philosopher and chemist, Joseph Priestley. Its first use as an anaesthetic gas in the treatment of a patient was when dentist, Horace Wells, assisted by Gardner Quincy Colton and John Mankey Riggs, demonstrated its pain relief during a dental extraction on 11 December 1844.1
Today
nitrous oxide is widely used globally in a variety of healthcare settings – ranging from dentists’ surgeries to Accident & Emergency Departments, paediatric, orthopaedic, ambulance, and Maternity units. All share the need for fast, safe, and effective pain relief during short procedures, and equally a rapid wearing off of the effects when surgery or other clinical procedures are complete. The economics of using N2
O also make it
an attractive proposition for healthcare providers compared with other options. Consequently, nitrous oxide is widely used in healthcare facilities in many countries – including the UK, Sweden, Norway, Finland, Australia, New Zealand, the US, and France.
One significant drawback of N2 O,
however, is its carbon footprint – with 1 kg of N2
O equivalent to 298 kg of CO2 .
Nitrous oxide alone contributes 2% of the total NHS England carbon footprint, and 75% of its total anaesthetic gas footprint. As a result, the NHS has a publicly stated aim of reducing its nitrous oxide emissions by 75% as part of the service’s wider goal of reducing greenhouse gas emissions by 80% within the next 7-11 years, and achieving ‘Net Zero’ by 2040.
A long-established form of pain relief The Maternity Department at Copenhagen’s Hvidovre Hospital, which is not only one of Denmark, but also Scandinavia’s, biggest and busiest, had been using nitrous oxide for pain relief for women in labour for some years, when, a decade ago, it took the decision to withdrew its use. Dorte Dahl, head Midwife at the Department of Obstetrics
Key partners
Alongside Medclair, other key participants in the successful installation of the central nitrous oxide destruction unit at Hvidovre Hospital in Copenhagen included: n Design, specification and commissioning of gas installation: Niras.
n Gas installation, and nitrous oxide and AGS solutions: Linde.
n AGS vacuum system: Busch Vacuum.
and Gynaecology, Hvidovre Hospital, explained: “Giving birth is not always a short procedure – it can be a lengthy one, with high pain intensity. Women will use a lot of nitrous oxide in these scenarios, which in turn gives rise to our two biggest concerns over the gas’s use today – staff being exposed to the gas, and its high global warming potential. We in fact stopped using nitrous oxide 10 years ago due to concerns about staff
being exposed, over time, to high levels of the gas. Staff safety is naturally one of our highest priorities, and we were not prepared to expose our staff to any excess risk. Subsequently, however, obstetricians, anaesthetists, midwives, medical technicians, and environmental specialists in Denmark developed a national protocol on how to use the gas safely in terms of exposure levels to staff. The protocol gives updated advice on its safe use, on the need for additional training, and on how to capture and destroy exhaled gas before it is released into the atmopshere.2
None
of these protocols, of course, existed at the time when, reluctantly, we took the decision to stop using N2
O.”
Demand from patients and nursing staff Dorte Dahl continued: “The decision to reintroduce nitrous oxide in our Maternity Department here was a result of demand from both women in labour and Maternity staff, and with the new protocols in place, all the Maternity Departments in Denmark now offer the anaesthetic gas to women in
O use, and with the gas a highly
Copenhagen’s Hvidovre Hospital. June 2023 Health Estate Journal 43
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