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 (n=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.