A survey of nitrous oxide use, attitudes and environmental sustainability considerations by anaesthetists across metropolitan local health districts in New South Wales

Nitrous oxide (N₂O) is a potent greenhouse gas used to provide analgesia and anaesthesia in healthcare. Leaks from the manifold-pipeline systems may result in significant losses of N₂O before delivery to the patient. The provision of N₂O by cylinder at point-of-care is proposed as a leak-reducing alternative to manifold-pipeline systems. The primary endpoint of this study was to determine the percentage of anaesthetists who considered it acceptable for N₂O to be supplied by cylinder rather than a manifold-pipeline system. It also explored the current application of N₂O and prevailing attitudes toward its environmental impact and future role in anaesthetic practice. A cross-sectional survey was administered in 2023 among anaesthetists working across seven metropolitan hospitals in New South Wales, Australia. Participants provided self-reported information on demographics, practice characteristics, views on climate change, the role of anaesthetists in addressing environmental concerns, routine N₂O usage, and the potential shift to cylinder supply of N₂O. Among the 287 respondents, the majority (<i>n</i>=241, 84.6%) were current users of N₂O, although most administered it infrequently (71.5% used it in less than 25% of cases). Attitudes regarding N₂O's environmental impact varied irrespective of career stage. Notably, 219 of 287 (76.3%) favoured using cylinders over the manifold-pipeline network. These findings indicate a decreasing trend in N₂O usage, especially among early career anaesthetists, and suggest that transitioning to cylinder supply is acceptable, provided that strategies are in place to manage supply disruptions without compromising patient care.