Study shows potential for ‘cracking’ technology

A study was published in Anesthesia (Journal of the Society of Anesthesiologists) showing the potential of using “fracking” technology to reduce the environmental impact of nitrous oxide (N2O), are widely used for pain management during labour.

The study was conducted by a multidisciplinary team of anesthesiologists and midwives, from St John’s Hospital, Livingston, UK, and the University of Manchester’s NHS Foundation Trust, Manchester, UK. The study’s lead author is Dr Annie Bender, a sustainable healthcare fellow at the Northwest School of Anesthesia, Manchester, UK. The study was supervised by Consultant Anesthesiologist Dr. Cliff Shelton from Wythenshaw Hospital and Lancaster University, UK.

All inhaled anesthetic gases in common use today are greenhouse gases. Compared to a carbon dioxide equivalent mass (CO .)2), nitrous oxide has 265 times the global warming potential. Nitrous oxide, the analgesic component of ‘gas and air’, is the most widely used labor analgesic in the UK and is available in all delivery settings. Thus, any intervention that reduces the release of nitrous oxide into the atmosphere has the potential to significantly reduce the environmental impact of this drug.

One method that may reduce the carbon footprint of nitrous oxide is by cracking (“cracking”) the exhaled gas into nitrogen and oxygen using a catalyst. Previous research has demonstrated the efficiency of this process – however, to be effective in practice, as much nitrous oxide must be ‘cleaned up’ (captured) so that it can be broken down. This depends on patients being able to breathe continuously in a mask or mouthpiece.

In this quality improvement project, based on environmental monitoring and employee feedback, the authors evaluated the impact of nitrous oxide cracking technology on the maternal environment. Nitrous oxide levels were recorded during the last 30 minutes of uncomplicated labor in 36 cases. In the first 12 cases, readings were taken without using technology to establish a baseline. Next, the study team introduced the crushing device, and took a stepwise approach to improving its clinical use. This involved using a mouthpiece, then two different types of face masks, and providing patients with tips for use and feedback.

The results showed that average ambient nitrous oxide levels were 71% lower than baseline when using the mouthpiece, and 81% lower when using a low-weight face mask (a lightweight face mask with an elastic seal) combined with the best method training. to use it. The authors say: “Given that a similar amount of reduction in nitrous oxide levels was observed with low-level mouthpieces and face masks, we suggest that pregnant women be offered a choice of either device when using the fraction. Education of pregnant women and the choice of device use is vital due to the degree of cooperation required high [for the successful use of the technology]This is consistent with the guidelines for selection and personal care in maternity services. Future research to characterize the optimal use of this technology could focus on investigating other types of delivery devices, and considering the optimal timing and method of education – eg, is the antenatal clinic a better place to discuss this technology than during the delivery period? “

The authors note that they tried to avoid burdening pregnant women with “climate guilt” during labour. For example by making it clear that greenhouse gas emissions associated with nitrous oxide are the responsibility of the healthcare organization – not the patients.

They add: “Employee feedback has been generally positive, although some found the technology to be cumbersome; successful implementation depends on effective employee participation. Our results indicate that fracturing technology can reduce ambient nitrous oxide levels in the generation environment, with potential to reduce Environmental influences and occupational exposure”.

Consultant Anesthesiologist Dr Cliff Shelton of the NHS Foundation, University of Manchester and Lancaster University, UK. c) +447806771901 e) cliff.shelton@nhs.net

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