Letters to the Editor.

Abstract

Working as a paediatric doctor it has recently come to my attention that nitrous oxide (N2O) is a particularly potent greenhouse gas and should be something that we aim to avoid using where possible or at least stringently control. The World Health Organization has named climate change the greatest threat to global health in the 21st century. As paediatricians, it is our duty to deliver holistic care and protect the future health of our patients and the world they will live in. We should be considering every choice of treatment carefully including the environmental impact it has. Nitrous oxide is increasingly popular for procedural sedation in the paediatric emergency department and the ward setting due to its quick onset, quick clearance and lack of respiratory depression. In Australia, it has had a noticeable rise in use in paediatrics since I started training in 2014. However, many anaesthetic departments are reducing the use of nitrous and in some cases are removing it from the operating room due to its global warming effect.1 N2O is a potent, long-lived greenhouse gas that has a global warming potential 265 times that of carbon dioxide.2, 3 As the worked example below shows, running a 70% nitrous: air mixture for 15 min is the equivalent of driving 130 km in an average car.4 Alternatives with reduced global warming potential might include oral or intranasal sedatives with adequate topical analgesia and distraction. Since discovering the terrible environmental impact of nitrous oxide, I use oral sedation for my ward procedural sedation: oral midazolam in the over 1-year old and chloral hydrate in those less than 1. This works just as well for me especially when employed with local anaesthetic and distraction. When choosing a therapy for a patient, the societal and planetary consequences of that choice need to be considered.3 The time has come for action, and we must avoid, reduce, reuse and recycle wherever we can.