Abstract
Nitrous oxide is a well-tolerated, colorless, odorless gas with medical applications that facilitate procedural sedation and operative care. Like volatile inhalational agents used by anesthesia, nitrous oxide poses occupational health hazards to serially exposed clinicians and, as a greenhouse gas, has environmental consequences. While the anesthesia community has encouraged significant reduction or elimination of nitrous oxide, non-anesthesiologists supporting pediatric procedural sedation outside of the operating room continue to value the use of nitrous oxide, as it is safely applied without requirement for advanced airway devices and does not compound the patient’s recovery from subsequently administered sedatives. Responsible use of nitrous oxide entails optimization of those aspects of gas delivery practices that are modifiable, and sedation teams can benefit from collaboration with occupational and environmental health experts. Following a recent longitudinal process improvement project with Industrial Hygiene, we present an editorial discussion on three concepts that influence our perspective on current and future use of nitrous oxide for procedural sedation in the pediatric population. Specifically, we discuss the risk of leak inherent to all gas delivery systems, present options to mitigate nitrous oxide’s carbon footprint, and explore the growing demand for pediatric sedation services outside of the traditional operating room.