A District General Hospital (DGH) Experience of Decommissioning the Nitrous Oxide (N2O) Cylinder Manifold: From Conception to Completion 

Dr Abigail Mann1, Dr Amy Baigent2 , Dr Rebecca Oram3 , Dr Jonathan Price4, Dr Rachael Meredith5, Dr Jamie Penketh6, Dr Rob Penders7 

1Clnical Fellow Anaesthetics Royal United Hospital Bath, 2ST5 Anaesthetics Royal United Hospital Bath,  3 ST6 Anaesthetics Bristol Royal Infirmary, 4Consultant Anesthetist Royal United Hospital Bath, 5CT3 Anaesthetics Royal United Hospital Bath, 6ST6 Anaesthetics Royal United Hospital Bath, 7ST7 Anaesthetics Bristol Royal Infirmary

Background

Nitrous oxide remains in the atmosphere for 114 years making its greenhouse effect equivalent to that of desflurane at clinically relevant levels1 and a global warming potential of 300 times that of carbon dioxide2.

 

Cylinder manifolds, the traditional storage unit of nitrous, leak significant amounts of the gas. Leakage may be more than is utilised in patient care3 leading to ongoing detrimental effects despite the reduction in consumption..

 

The Royal United Hospital (RUH) in Bath has seventeen operating theatres covering three areas delivering an average of 10,000 general anaesthetics per year, including 1200 paediatric cases4. It has a sustainability goal of becoming carbon neutral by 20502.

 

With the help of the nitrous oxide working group we have successfully decommissioned the nitrous oxide manifold and exchanged for a more economical and environmental option – portable size E cylinders.