Reducing nitrous oxide use in theatres

Rachel McLean
Rachel McLean • 13 April 2019

Setting/Patient Group: Trust-wide

Issue to be addressed:

5% of the carbon footprint of acute NHS trusts comes from anaesthetic gases. There are alternatives to nitrous oxide which maintain clinical outcomes without negative environmental impacts but are not yet normalised within the trust.


The aim was to eliminate nitrous oxide use (apart from maternity) within the trust. To do this the anaesthetics team used the following methods:

  1. 1. Informal conversations with colleagues (face to face and email
  2. 2. Measurement of carbon impact of nitrous oxide within trust to quantify environmental impact.
  3. 3. An education session in departmental clinical governance meeting, followed by a debate.
  4. 4. Application of reminder stickers to encourage minimal use of gas required for effective anaesthesia.

Cumulative outcomes:


  • Nitrous oxide has adverse effects on some patients including nausea and hypoxia.



  • Estimated total carbon saving 2,607kgCO2e/year


  • Estimated total cost saving of £42,798/year

Key learning point

Sometimes we don’t get the result we hope for - the vote following debate fell in favour of keeping nitrous oxide rather than elimination as most anaesthetists wanted the option of using it.

Resource author(s)
Swarbrick C, Valentine P, Martin F, Ford P and Martin A.
Resource publishing organisation(s) or journal
Royal Devon & Exeter NHS Foundation Trust
Resource publication date
April 2019

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