Reducing Greenhouse Gas Emissions and Modifying Nitrous Oxide Delivery at Stanford: Observational, Pilot Intervention Study
BackgroundInhalational anesthetic agents are a major source of potent greenhouse gases in the medical sector, and reducing their emissions is a readily addressable goal. Nitrous oxide (N2O) has a long environmental half-life relative to carbon dioxide combined with a low clin...
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JMIR Publications
2025-01-01
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| Series: | JMIR Perioperative Medicine |
| Online Access: | https://periop.jmir.org/2025/1/e64921 |
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| author | Eric P Kraybill David Chen Saadat Khan Praveen Kalra |
| author_facet | Eric P Kraybill David Chen Saadat Khan Praveen Kalra |
| author_sort | Eric P Kraybill |
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BackgroundInhalational anesthetic agents are a major source of potent greenhouse gases in the medical sector, and reducing their emissions is a readily addressable goal. Nitrous oxide (N2O) has a long environmental half-life relative to carbon dioxide combined with a low clinical potency, leading to relatively large amounts of N2O being stored in cryogenic tanks and H cylinders for use, increasing the chance of pollution through leaks. Building on previous findings, Stanford Health Care’s (SHC’s) N2O emissions were analyzed at 2 campuses and targeted for waste reduction as a precursor to system-wide reductions.
ObjectiveWe aimed to determine the extent of N2O pollution at SHC and subsequently whether using E-cylinders for N2O storage and delivery at the point of care in SHC’s ambulatory surgery centers could reduce system-wide emissions.
MethodsIn phase 1, total SHC (Palo Alto, California) N2O purchase data for calendar year 2022 were collected and compared (volume and cost) to total Palo Alto clinical delivery data using Epic electronic health records. In phase 2, a pilot study was conducted in the 8 operating rooms of SHC campus A (Redwood City). The central N2O pipelines were disconnected, and E-cylinders were used in each operating room. E-cylinders were weighed before and after use on a weekly basis for comparison to Epic N2O delivery data over a 5-week period. In phase 3, after successful implementation, the same methodology was applied to campus B, one of 3 facilities in Palo Alto.
ResultsIn phase 1, total N2O purchased in 2022 was 8,217,449 L (33,201.8 lbs) at a total cost of US $63,298. Of this, only 780,882.2 L (9.5%) of N2O was delivered to patients, with 7,436,566.8 L (90.5%) or US $57,285 worth lost or wasted. In phase 2, the total mass of N2O use from E-cylinders was 7.4 lbs (1 lb N2O=247.5 L) or 1831.5 L at campus A. Epic data showed that the total N2O volume delivered was 1839.3 L (7.4 lbs). In phase 3, the total mass of N2O use from E-cylinders was 10.4 lbs or 2574 L at campus B (confirming reliability within error propagation margins). Epic data showed that the total N2O volume delivered was 2840.3 L (11.5 lbs). Over phases 2 and 3, total use for campuses A and B was less than the volume of 3 E-cylinders (1 E-cylinder=1590 L).
ConclusionsConverting N2O delivery from centralized storage to point-of-care E-cylinders dramatically reduced waste and expense with no detriment to patient care. Our results provide strong evidence for analyzing N2O storage in health care systems that rely on centralized storage, and consideration of E-cylinder implementation to reduce emissions. The reduction in N2O waste will help meet SHC’s goal of reducing scope 1 and 2 emissions by 50% before 2030. |
| format | Article |
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| institution | Kabale University |
| issn | 2561-9128 |
| language | English |
| publishDate | 2025-01-01 |
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| series | JMIR Perioperative Medicine |
| spelling | doaj-art-482dff98a31943aa9802825b2b0760612025-01-09T16:01:23ZengJMIR PublicationsJMIR Perioperative Medicine2561-91282025-01-018e6492110.2196/64921Reducing Greenhouse Gas Emissions and Modifying Nitrous Oxide Delivery at Stanford: Observational, Pilot Intervention StudyEric P Kraybillhttps://orcid.org/0009-0009-1669-4848David Chenhttps://orcid.org/0000-0001-9552-5659Saadat Khanhttps://orcid.org/0009-0003-2863-6190Praveen Kalrahttps://orcid.org/0009-0003-4582-7036 BackgroundInhalational anesthetic agents are a major source of potent greenhouse gases in the medical sector, and reducing their emissions is a readily addressable goal. Nitrous oxide (N2O) has a long environmental half-life relative to carbon dioxide combined with a low clinical potency, leading to relatively large amounts of N2O being stored in cryogenic tanks and H cylinders for use, increasing the chance of pollution through leaks. Building on previous findings, Stanford Health Care’s (SHC’s) N2O emissions were analyzed at 2 campuses and targeted for waste reduction as a precursor to system-wide reductions. ObjectiveWe aimed to determine the extent of N2O pollution at SHC and subsequently whether using E-cylinders for N2O storage and delivery at the point of care in SHC’s ambulatory surgery centers could reduce system-wide emissions. MethodsIn phase 1, total SHC (Palo Alto, California) N2O purchase data for calendar year 2022 were collected and compared (volume and cost) to total Palo Alto clinical delivery data using Epic electronic health records. In phase 2, a pilot study was conducted in the 8 operating rooms of SHC campus A (Redwood City). The central N2O pipelines were disconnected, and E-cylinders were used in each operating room. E-cylinders were weighed before and after use on a weekly basis for comparison to Epic N2O delivery data over a 5-week period. In phase 3, after successful implementation, the same methodology was applied to campus B, one of 3 facilities in Palo Alto. ResultsIn phase 1, total N2O purchased in 2022 was 8,217,449 L (33,201.8 lbs) at a total cost of US $63,298. Of this, only 780,882.2 L (9.5%) of N2O was delivered to patients, with 7,436,566.8 L (90.5%) or US $57,285 worth lost or wasted. In phase 2, the total mass of N2O use from E-cylinders was 7.4 lbs (1 lb N2O=247.5 L) or 1831.5 L at campus A. Epic data showed that the total N2O volume delivered was 1839.3 L (7.4 lbs). In phase 3, the total mass of N2O use from E-cylinders was 10.4 lbs or 2574 L at campus B (confirming reliability within error propagation margins). Epic data showed that the total N2O volume delivered was 2840.3 L (11.5 lbs). Over phases 2 and 3, total use for campuses A and B was less than the volume of 3 E-cylinders (1 E-cylinder=1590 L). ConclusionsConverting N2O delivery from centralized storage to point-of-care E-cylinders dramatically reduced waste and expense with no detriment to patient care. Our results provide strong evidence for analyzing N2O storage in health care systems that rely on centralized storage, and consideration of E-cylinder implementation to reduce emissions. The reduction in N2O waste will help meet SHC’s goal of reducing scope 1 and 2 emissions by 50% before 2030.https://periop.jmir.org/2025/1/e64921 |
| spellingShingle | Eric P Kraybill David Chen Saadat Khan Praveen Kalra Reducing Greenhouse Gas Emissions and Modifying Nitrous Oxide Delivery at Stanford: Observational, Pilot Intervention Study JMIR Perioperative Medicine |
| title | Reducing Greenhouse Gas Emissions and Modifying Nitrous Oxide Delivery at Stanford: Observational, Pilot Intervention Study |
| title_full | Reducing Greenhouse Gas Emissions and Modifying Nitrous Oxide Delivery at Stanford: Observational, Pilot Intervention Study |
| title_fullStr | Reducing Greenhouse Gas Emissions and Modifying Nitrous Oxide Delivery at Stanford: Observational, Pilot Intervention Study |
| title_full_unstemmed | Reducing Greenhouse Gas Emissions and Modifying Nitrous Oxide Delivery at Stanford: Observational, Pilot Intervention Study |
| title_short | Reducing Greenhouse Gas Emissions and Modifying Nitrous Oxide Delivery at Stanford: Observational, Pilot Intervention Study |
| title_sort | reducing greenhouse gas emissions and modifying nitrous oxide delivery at stanford observational pilot intervention study |
| url | https://periop.jmir.org/2025/1/e64921 |
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