ANAESTHETIC GASES Reducing N2 O emissions with Scandinavian solutions


Nitrous oxide, used widely across the healthcare system for pain relief, was identified as one of the anaesthetic gases responsible for 2% of the UK health service’s emissions by the NHS. In this article, Jannik Jensen, International sales manager at Medclair, explores how Scandinavian solutions can be adopted to reduce the environmental impact.


Nitrous oxide (N2 0) is an analgesic gas


used widely across the healthcare system – in applications ranging from surgery and dentistry to non-surgical use, including maternity and emergency care. It is mostly considered a safe and effective pharmaceutical,1


and can be


mixed with oxygen and inhaled through a mask or a mouthpiece, making it less invasive than other methods of pharmaceutical administration. Its effects also wear off quickly, meaning a fast patient recovery and reduced observation time for staff. However, nitrous oxide also carries a heavy carbon footprint. The 2020 report, Delivering a ‘Net Zero’ National Health Service, identified anaesthetic gases as one of the sources of direct emissions from owned or directly controlled sources on site, accounting for 2% of NHS emissions. Nitrous oxide is one of the most harmful gases in the anaesthetic


group. To counteract the harmful effects of nitrous oxide, its use in hospitals urgently needs to evolve.


The Scandinavian model The environmental impact of nitrous oxide has been understood in Sweden for some time, where technology for the capture and destruction of the gas has been readily deployed for around 16 years. Swedish hospitals use a central destruction unit to destroy nitrous oxide from many different rooms at the same time, for example in a maternity unit. Meanwhile, mobile destruction units are used to handle single rooms like dental surgeries, emergency rooms, and those used for orthopaedics, endoscopy, ambulatory care, and paediatrics. If the technology implemented in Sweden was applied across 132 high- impact Trusts in UK, it could cut over one- third of NHS anaesthetic emissions, an


estimated 90 kilotons of carbon dioxide equivalent (ktCO2


e). Scaled across the


entire health service, it could deliver up to a 75% reduction in nitrous emissions.2


Destroying nitrous oxide to protect the planet


Globally, anaesthetic gases are estimated to contribute 0.6% of healthcare’s total climate change impact.3


Nitrous oxide is


also one of the key gases contributing to the greenhouse effect, the process of trapping heat in the atmosphere. Carbon dioxide and methane also belong to this group of potent greenhouse gases. However, despite existing in much smaller concentrations, nitrous oxide traps approximately 300 times as much heat as carbon dioxide.


The environmental impact of nitrous oxide can be illustrated through comparison with the emission of carbon dioxide during a single car trip. The use of nitrous oxide for one hour at one litre per minute has the CO2


equivalency of driving


a car for 95 kilometres. When you consider that one litre per minute is almost irrelevant as a clinical dosage – a maternity department, for example, will deliver much higher volumes at normal use – the scale of the issue becomes even more apparent. Climate change is also a health emergency. It represents a threat to the health systems’ ability to deliver high- quality care, and undermines the gains in public health achieved in the past half- century, carrying the risk of more intense heatwaves, danger of flooding and damaging storms, and a changing pattern of emerging infectious diseases. The healthcare sector now has a key role to play in climate change mitigation efforts, which can not only substantially reduce emissions, but also lead to enhanced patient care, staff satisfaction, and cost savings.4


Capturing nitrous oxide to keep staff safe


A central destruction unit can destroy nitrous oxide from many different rooms. It is used in settings where gas evacuating pipelines are present, such as delivery rooms on maternity wards.


Not only harmful to the environment, nitrous oxide can also pose risks to the safety and wellbeing of healthcare


October 2021 Health Estate Journal 81


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