Reducing Nitrous Oxide Utilization as Part of a Greener Anesthesia Program: Outcomes from a Tertiary Care Center

ABSTRACT: Nitrous oxide (N2O) is well known for its sedative and analgesic effects. However, its environmental impact and contribution to greenhouse gas emissions have garnered increasing attention, leading to a gradual phase-out in anesthesia practice. In many locations where N2O is being gradually replaced, medical gas pipeline systems (MGPSs) are still in place. The delivery of N2O through these systems presents another concern, as leakage poses a significant environmental hazard. At our tertiary care institute, the MGPS supply of N2O was fully discontinued in January 2021. A retrospective analysis of N2O cylinder consumption in the operation theaters of our tertiary care institute was conducted from January 2021 to December 2024. The analysis revealed a steady and substantial decline in N2O usage following the discontinuation of MGPS supply and the gradual adoption of medical air. These findings reflect a successful institutional shift toward more sustainable anesthesia practices.