{"id":4827,"date":"2025-05-23T16:35:37","date_gmt":"2025-05-23T08:35:37","guid":{"rendered":"https:\/\/medicine.nus.edu.sg\/cosm\/?post_type=stories&#038;p=4827"},"modified":"2025-10-02T11:47:46","modified_gmt":"2025-10-02T03:47:46","slug":"mitigating-nitrous-oxide-leaks","status":"publish","type":"stories","link":"https:\/\/medicine.nus.edu.sg\/cosm\/stories\/mitigating-nitrous-oxide-leaks\/","title":{"rendered":"Mitigating Nitrous Oxide Leaks"},"content":{"rendered":"\n\n\t\t\t<img decoding=\"async\" loading='false' src=\"https:\/\/medicine.nus.edu.sg\/cosm\/wp-content\/uploads\/sites\/34\/2025\/05\/Untitled-design-18.png\" alt=\"\" \/>\t\t\t\n\t\t\t\t<h2>Mitigating Nitrous Oxide Leaks<\/h2>\t\t\t\n\t<h5>At Changi General Hospital (CGH), Dr Michelle Tan and her team tackled a hidden source of emissions &#8211; wasting nitrous oxide (N\u2082O) used in Anaesthesia. By switching to a portable small-cylinder system and decommissioning the hospital&#8217;s central pipeline, they achieve a dramatic reduction in greenhouse gas emissions and costs, while maintaining safe and effective patient care.\u00a0\u00a0<\/h5>\n\t<iframe loading=\"lazy\" width=\"560\" height=\"315\" src=\"https:\/\/www.youtube.com\/embed\/hs0D49rd5PQ?si=rmluh_CNGnK7-5Qv\" title=\"YouTube video player\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<h1>\n\t\tThe Challenge\n\t<\/h1>\n\t<p>Nitrous oxide commonly known as laughing gas, has been as an anaesthetic for over a century. But, it is also a potent greenhouse gas &#8211;\u00a0 273 times more damaging than carbon dioxide &#8211;\u00a0 and contributes to ozone layer depletion.<\/p>\n<p>Globally, studies show that 70-95% of N\u2082O is wasted through hospital pipelines and manifolds system before ever reaching a patient.<\/p>\n<p>At CGH, Dr Michelle Tan and her team used\u00a0 Electronic Health Record (EHR) anaesthesia data\u00a0 to investigate local usage patterns. They\u00a0 found that up to 74% of N\u2082O was wasted annually, amount to more than 800 tonnes of CO\u2082e emissions over two years.<\/p>\n\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/cosm\/wp-content\/uploads\/sites\/34\/2025\/05\/Untitled-design-17.png\" alt=\"Untitled design (17)\" itemprop=\"image\" height=\"533\" width=\"800\" title=\"Untitled design (17)\" onerror=\"this.style.display='none'\"  \/>\n\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/cosm\/wp-content\/uploads\/sites\/34\/2025\/05\/Untitled-design-25.png\" alt=\"Untitled design (25)\" itemprop=\"image\" height=\"533\" width=\"800\" title=\"Untitled design (25)\" onerror=\"this.style.display='none'\"  \/>\n<h1>\n\t\tThe Approach\n\t<\/h1>\n\t<p>By comparing EHR0-tracked N\u2082O usage with procurement records, the team was able to quantify waste and identify the hospital&#8217;s central manifold pipeline system as the key source of wastage.<\/p>\n<p>In 2024, CGH decommissioned its N\u2082O manifold system and introduced a new set up: portable cylinder tanks attached directly to anaesthesia machines in each operating theatre. This reduced the distance gas needed to travel and minimized leak points, while maintaining a safe and steady supply for clinical use.<\/p>\n<h1>\n\t\tThe Impact\n\t<\/h1>\n\t<p>The intervention led to 94% reduction in nitrous oxide wastage and avoided over 400 tonnes of CO\u2082e emissions each year &#8211; the same as 6,700 cars driving from Singapore to Kuala Lumpur. The hospital also saw significant cost savings as a result of reduced gas loss.<\/p>\n<p>Because the approach relies on readily available EHR data and off-the shelf cylinder systems, it offers a replicable and scalable model for other hospitals across Singapore and beyond.<\/p>\n<h1>\n\t\tDo you have a similar story to share?\n\t<\/h1>\n\t<p>Share your experience. Inspire others. Help shape what sustainable medicine looks like.<\/p>\n\t\t\t<a href=\"mailto:cosm@nus.edu.sg\" target=\"_blank\" rel=\"noopener\">\n\t\t\t\t\t\tEmail us\n\t\t\t\t\t<\/a>\n\t\t\t<a href=\"https:\/\/forms.gle\/zMCdeMJ2S5oE2P9q9\" target=\"_self\">\n\t\t\t\t\t\tSubmit your #SustainableHealthStories\n\t\t\t\t\t<\/a>\n<h1>\n\t\tFor more information\n\t<\/h1>\n\t<p>Michelle Bee Hua Tan,\u00a0William Gagnon,\u00a0Huae Min Tham,\u00a0Li Wen Ong,\u00a0Bernard Tiang Guan Koh,\u00a0Srinath Sridharan,\u00a0Xuan Han Koh,\u00a0Jo-Anne Yeo, <a href=\"https:\/\/www.bjanaesthesia.org.uk\/article\/S0007-0912(24)00768-2\/abstract\"><strong>Utilising electronic anaesthesia records to audit nitrous oxide consumption and waste, and implementation of a loss monitoring system<\/strong><\/a>, British Journal of Anaesthesia, 2025<\/p>\n<h1>\n\t\tAcknowledgements\n\t<\/h1>\n\t<p>The Centre for Sustainable Medicine would like to thank Dr Tan, Dr Ang, Nurse Gurdip, Ms Ong, Mr Sridharan, Mr Tiang and the whole medical team for leading the transition, as well as to the Communications team at Changi General Hospital for their invaluable support.<\/p>\n\n","protected":false},"excerpt":{"rendered":"<p>Mitigating Nitrous Oxide Leaks At Changi General Hospital (CGH), Dr Michelle Tan and her team tackled a hidden source of emissions &#8211; wasting nitrous oxide (N\u2082O) used in Anaesthesia. By switching to a portable small-cylinder system and decommissioning the hospital&#8217;s central pipeline, they achieve a dramatic reduction in greenhouse gas emissions and costs, while maintaining [&hellip;]<\/p>\n","protected":false},"featured_media":4853,"menu_order":0,"template":"","meta":{"_acf_changed":false,"site-sidebar-layout":"no-sidebar","site-content-layout":"page-builder","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"disabled","ast-breadcrumbs-content":"","ast-featured-img":"disabled","footer-sml-layout":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"tags":[],"story-category":[],"class_list":["post-4827","stories","type-stories","status-publish","has-post-thumbnail","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Mitigating Nitrous Oxide Leaks - Centre for Sustainable Medicine<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/medicine.nus.edu.sg\/cosm\/stories\/mitigating-nitrous-oxide-leaks\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Mitigating Nitrous Oxide Leaks - Centre for Sustainable Medicine\" \/>\n<meta property=\"og:description\" content=\"Mitigating Nitrous Oxide Leaks At Changi General Hospital (CGH), Dr Michelle Tan and her team tackled a hidden source of emissions &#8211; wasting nitrous oxide (N\u2082O) used in Anaesthesia. 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