Laughing gas, no laughing matter
Analyzing the Technical, Clinical, and Infrastructural Dimensions of Nitrous Oxide for a more sustainable future
H.F. Winder (TU Delft - Mechanical Engineering)
J. Dankelman – Graduation committee member (TU Delft - Mechanical Engineering)
Anne van der Eijk – Mentor (Leiden University Medical Center)
Claar Lap – Mentor (Leiden University Medical Center)
More Info
expand_more
Other than for strictly personal use, it is not permitted to download, forward or distribute the text or part of it, without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license such as Creative Commons.
Abstract
Nitrous oxide ( N2O ) is a widely used inhalational analgesic and anesthetic across clinical settings including obstetrics, pediatrics, emergency medicine, and dentistry. However, its global warming potential (273 times that of CO2 over a 100-year horizon) and documented occupational health risks make its unmitigated clinical use increasingly difficult to justify within contemporary sustainability frameworks.
This thesis provides a comprehensive, multi-dimensional evaluation of N2O management in healthcare, integrating a systematic technology review, an institutional case study at Leiden University Medical Center (LUMC), and a clinical deep-dive into obstetric practice.
Chapter 1 maps the global landscape of N2O delivery, scavenging, and destruction technologies across a dataset of 60 devices from 19 manufacturers. Findings reveal that 78.3% of catalogued systems provide zero active greenhouse gas mitigation, with true catalytic destruction present in only 11.7% of devices. Significant geopolitical stratification limits technology access in lower-income healthcare systems, while regional regulatory divergence drives fragmented clinical adoption.
Chapter 2 quantifies seven years of institutional N2O consumption at LUMC (2019–2025), modeling cumulative unmitigated emissions of 103,637 kg CO2-eq across four departments. The sharpest emissions growth was driven by the 2023 introduction of N2O -based cryoanalgesia for pediatric pectus excavatum repair. Substantial discrepancies between theoretical and real-world carbon footprints were identified, attributable to point-of-use catalytic destruction systems and infrastructural transitions. Critical regulatory compliance gaps in ambient occupational exposure monitoring were documented.
Chapter 3 analyzes 403 obstetric labor episodes at LUMC. Despite modest objective pain reduction (mean VAS decrease of 1.63 ± 1.48 points), patient and provider satisfaction scores remained high (7.31 and 7.76 out of 10, respectively), illustrating the well-documented analgesic paradox of N2O . The overall analgesic conversion rate to epidural or remifentanil analgesia was 18.35%, rising to 25.37% among primiparous patients, supporting risk-stratified clinical routing recommendations.
Collectively, these findings demonstrate that sustainable N2O governance cannot be achieved through isolated end-of-pipe solutions. Instead, institutions require a coordinated strategy encompassing decentralized cylinder-based supply, workflow-matched abatement technologies, risk-stratified clinical protocols, and governance structures that integrate frontline clinical expertise. The Dutch regulatory framework, combining occupational health law, sustainability covenants, and professional clinical standards, is identified as an instructive model for international healthcare systems seeking to reduce direct anesthetic gas emissions without compromising patient care.