Three years ago, Los Angeles-based Keck Medical Center of USC became the first academic medical center to fully discontinue using nitrous oxide in its operating room, and it has never looked back.
Nitrous oxide, more commonly known as laughing gas, is a greenhouse gas roughly 300 times more potent than carbon dioxide. It can last in the atmosphere for about 100 years, which means some of the first nitrous oxide used in clinical care as an anesthetic is still lingering in the atmosphere today, Arash Motamed, MD, anesthesiologist and medical director of sustainability with Keck Medicine, said on an upcoming Becker’s podcast episode. Studies have found that anywhere between 75% to 95% of nitrous oxide leaks at connection points, and leaks are not preventable. This means most of the nitrous oxide in clinical care does not have an impact on patients but goes straight into the atmosphere.
“Given my involvement in sustainability efforts with Keck Medicine, I felt compelled to address this,” Dr. Motamed said.
He started by educating staff about the impact of nitrous oxide and partnered with facility colleagues to begin making changes. The gas was delivered to the OR either in cylinders attached to the anesthesia machine or via central pipelines. Dr. Motamed and his colleagues decided to fully remove laughing gas from the OR but kept a few cylinders in reserve in case they were needed. In three years, they have never been used.
While removing the gas from the OR, they encountered a few issues. The anesthesia machines themselves could no longer complete a self-check when disconnected from the laughing gas, so it would generate errors that rendered the machines non-functional. Dr. Motamed and his team had to contact the manufacturer and have a representative input special codes to reconfigure the self-check so the machines would function properly.
The next challenge came from decommissioning the central pipelines. Removing the pipes from the building was not feasible, so leaders worked with the facilities management team to enact a creative solution: filling the pipes with nitrogen. This preserved the structural integrity of the pipes for potential future use, was inexpensive and had no negative environmental impact.
The system has also cut down use of desflurane, which is the most potent inhaled anesthetic, and is targeting isoflurane and sevoflurane next.
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