ANZCA/ASA/NZSA release a joint statement on decommissioning nitrous oxide for medical gas pipeline systems.
Anaesthetists continue to demonstrate leadership in decarbonising healthcare with ANZCA’s Environmental Sustainability Network (ESN) Executive Sub-committee instrumental in the development of this joint statement.
Our joint statement with the Australian Society of Anaesthetists (ASA) and the New Zealand Society of Anaesthetists (NZSA) reflects a collaborative bi-national approach to nitrous oxide (N2O). N2O is a greenhouse gas that contributes to climate change, and the healthcare contribution to its emissions requires urgent and decisive action.
The statement on decommissioning N2O medical gas pipeline systems (N2O MGPS) aims to strengthen patient safety and environmental sustainability by promoting universal support for:
- Decommissioning N2O MGPS.
- Avoiding installation of new N2O MGPS.
- Utilising point of care cylinder supply where N2O is required for clinical use.
This statement does not propose to impact or change clinical indications for use of N2O.
The reduction of N2O is a key action of the Australian Governments’ Department of Health, Disability and Ageing National Health and Climate Strategy. To support this, the practical guide on detecting and reducing leaks from nitrous oxide in healthcare facilities was released in 2024.
The statement is in line with the 2024 release from United Kingdom and Irish Anaesthetic societies, and the American Society of Anesthesiologists, advocating for decommissioning existing N2O MGPS and not installing N2O MGPS in new hospitals. Furthermore, in September 2025 the World Health Organization (WHO) added a qualifying statement to the emergency medicines list with changes to the listing of N2O and the recommendation for use of point-of-care cylinders.
This work is supported by ANZCA PS64(G) Position statement on environmental sustainability in anaesthesia and pain medicine practice 2019 (currently in review) and the ANZCA Council Statement on Climate Change.
In 2024 the joint statement: Working together to achieve sustainable high-quality health care in a changing climate was released as a shared commitment with the Australian Commission on Safety and Quality in Health Care, interim Australian Centre for Disease Control, Council of Presidents of Medical Colleges (CPMC) representing all medical colleges, and the Australian Indigenous Doctors’ Association (AIDA).
The ASA’s support of the Environment and Sustainability Statement (2021) from the Common Issues Group (CIG) outlines the group's recognition that the professional actions of anaesthesiologists have a significant environmental impact which affects health and economies.
The NZSA Environmental and Sustainability Network aims to reduce the carbon footprint of healthcare and other activities to mitigate climate change, and highlighted Dunedin’s decommissioning reticulated nitrous oxide in NZ Anaesthesia Issue (71) April 2025 and with latest issue December 2025 article on Decommissioning nitrous oxide across Aotearoa.
N2O is a topical item for anaesthetists and was included as an article in the recent 2025 Blue Book titled Back to the future: A return to point-of-care nitrous oxide cylinders (p289), along with the 2025 ANZCA Winter Bulletin article Tackling leaks from nitrous oxide infrastructure (p24-25).
The statement further strengthens anaesthetists’ commitment, actions and measures to minimise the health impact of climate change and promote environmental sustainability, building on from the 2024 release of ANZCA’s statement on desflurane.
We recognise the need for urgent action on climate change, and mitigating the effects of anaesthesia gases on planetary health is one initiative of a wider comprehensive suite of strategies to do so.
We've contributed to or endorsed a selection of guidelines and statements developed by other organisations.
ANZCA is committed to minimising the health impact of climate change and promoting environmental sustainability, and has taken measures to reduce its environmental impact. Here are some of the ways we are doing this.
The purpose of the ESN is “to advocate, collaborate and promote initiatives and projects related to environmental sustainability within anaesthesia, perioperative and pain medicine”.
