Pipeline nitrous oxide should no longer be considered as a means of supplying nitrous oxide in modern anaesthetic practice, according to leading anaesthetic organisations in the UK and Ireland, who are calling for decommissioning of nitrous oxide manifolds.
The recommendation relates to pipeline pure nitrous oxide only, meaning nitrous oxide will remain available via point-of-use cylinders in circumstances where it is judged beneficial to patient care. The organisations behind the call say decommissioning will enable NHS Trusts and Health Boards ‘to save money and reduce their environmental impact, while maintaining the highest standards of anaesthetic care for patients’. It will not affect use of Entonox, a mixture of nitrous oxide and oxygen commonly known as ‘gas and air’ used for pain relief, including for women in labour.
The recommendation comes in the form of a ‘consensus statement’ led by the Royal College of Anaesthetists (RCoA), in partnership with the Association of Anaesthetists, the College of Anaesthesiologists of Ireland (CAI), the Obstetric Anaesthetists’ Association (OAA), and the Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI).
The organisations says many anaesthetists have already moved away from routine nitrous oxide use in general anaesthesia, and the new guidance will give Trusts and Health Boards ‘the clinical steer’ they need to decommission manifolds of cylinders within hospitals. The Colleges and Associations said: “The majority of manifolds have a significant leak, with 80-100% of nitrous oxide leaking out to the atmosphere before reaching the point of delivery. This is costly, and has an environmental impact, because nitrous oxide is a long-lived greenhouse gas with an atmospheric lifetime of over 100 years. Decommissioning pipelines will support NHS Net Zero goals, and have financial savings for Trusts and Health Boards.”
The consensus statement recommends that the transition from nitrous oxide manifolds is completed by the end of the 2026/2027 financial year in the UK and the Republic of Ireland, with Trusts and Health Boards advised to liaise with their supplier to ensure the increased demand for point-of-use nitrous oxide cylinders can be met and maintained.
Dr Helgi Johannsson, Vice President and Sustainability Lead of the Royal College of Anaesthetists (pictured), said: “For the first time, all the leading anaesthetic organisations in the UK and Ireland are giving clear clinical guidance that we don’t need pipeline pure nitrous oxide to maintain the highest standards of anaesthetic care for our patients. We hope this new guidance will give Trusts and Health Boards the backing they need to get rid of leaky manifolds in hospitals, which will reduce greenhouse gas emissions and save money.”
Dr Ken Barker, Chair of the Association of Anaesthetists Environment and Sustainability Committee of the Association of Anaesthetists, added: “This joint statement addresses a wasteful practice that has allowed unnecessary leakage of nitrous oxide, a long-lived climate pollutant, from NHS hospitals. Simply by providing this gas where and when it is required for patient care via local cylinders, rather than hospital-wide pipeline systems, clinicians can substantially reduce the NHS carbon footprint without compromising safety or standards.”
