Study Shows Potential for 'Cracking' Technology to Reduce Environmental Impact of Nitrous Oxide Used During Labor

Research published in anesthesia Nitrous oxide (N₂O), widely used to manage pain during labour.

This study was conducted by a multidisciplinary team of anesthesiologists and midwives from St John’s Hospital, Livingstone, UK and the University of Manchester NHS Foundation Trust, Manchester, UK. The lead author of the study is Dr. Annie Pinder, Fellow in Sustainable Health Care, North West School of Anaesthesia, Manchester, UK. The study was supervised by Dr. Cliff Shelton, Consultant Anesthesiologist at Wythenshaw Hospital and Lancaster University, UK.

All inhalation anesthetic gases commonly used today are greenhouse gases. Equivalent mass of carbon dioxide (CO₂), nitrous oxide has 265 times the global warming potential. Nitrous oxide, the ‘gas and air’ analgesic ingredient, is the most frequently used labor pain reliever in the UK and is available in all birthing settings. Reducing interventions may significantly reduce the environmental impact of this drug.

One way that nitrous oxide’s carbon footprint can be reduced is by using a catalyst to break down (“crack”) the exhaled gas into nitrogen and oxygen. Previous studies have established the efficiency of this process, but to be effective, as much exhaled air as possible must be “removed” (captured) so that the exhaled nitrous oxide can be broken down. there is. It relies on the patient being able to exhale consistently into the mask or mouthpiece.

In this quality improvement project, based on environmental monitoring and staff feedback, the authors evaluated the impact of nitrous oxide cracking technology in the birthing environment. Nitrous oxide levels were recorded during her last 30 min of 36 simple deliveries. In the first 12 cases, measurements were obtained without the use of technology to establish baselines. The research team then introduced the cracking device and took a stepwise approach to optimize its clinical use. This included using two types of face masks after using the mouthpiece and providing usage tips and feedback to the patient.

As a result, median ambient nitrous oxide levels were 71% lower than baseline with mouthpieces, compared with low-profile facemasks (lightweight facemasks with flexible seals) and optimal usage. 81% lower when combined with coaching.

The authors concluded, “Given that similar reductions in nitrous oxide levels were seen with mouthpieces and discreet face masks, pregnant women should have the option of either device when using cracking.” We propose that it is necessary to provide education for pregnant women and the use of the device is very important given the high degree of cooperation required. [for the successful use of the technology], and this is consistent with guidelines for selection and individualized care in obstetric services. Future research to better characterize the optimal use of this technology could focus on investigating other types of delivery devices, examining optimal timing and methods of education. “

The authors say they tried not to burden pregnant women with “climate guilt” during labor. For example, by making it clear that nitrous oxide-related greenhouse gas emissions are the responsibility of healthcare providers, not patients.

“Feedback from staff has been generally positive, although some found the technology to be unwieldy. Successful implementation relies on effective staff engagement. reduces ambient nitrous oxide levels in the obstetric environment, indicating that environmental impacts and occupational exposures.”

Provided by AAGBI