Measure ID
SUS-05-Peds
Domain
Description

Percentage of pediatric patients < 18 years old where nitrous oxide is avoided during anesthesia.

Measure Type
Process
Available for Provider Feedback
Yes
Threshold
90%
Rationale

Inhalational agents (halogenated hydrocarbons and nitrous oxide) leaking or vented into the atmosphere are environmental pollutants with significant global warming potential.

N2O is both a potent greenhouse gas and an ozone depleting agent. N2O has an atmospheric lifetime of 114 years, the longest of the commonly used inhaled agents. Thus, the use of N2O as a carrier gas compared to air/oxygen substantially increases the global warming impact in the operating room. Eliminating the use of nitrous oxide in the operating room can decrease occupational exposure, public health harm, and cost of anesthesia without compromising patient care.1-7

Agent

Global Warming Potential100

Atmospheric Lifetime (years)

Molecular Weight (g/mol)

Isoflurane4

565

3.2

184.5

Sevoflurane3

144

1.1

200

Desflurane4

2720

14

169

Nitrous Oxide5

282*

114

44

Table adapted from American Society of Anesthesiologists’ Task Force on Environmental Sustainability Committee on Equipment and Facilities: Greening the Operating Room and Perioperative Arena: Environmental Sustainability for Anesthesia Practice2

*Nitrous oxide value is derived as an average of the range provided on the EPA website: 265-298.

 

Measure Time Period

Induction Start to Intubation. If not available, then Induction End

Inclusions

Pediatric patients undergoing general anesthesia (determined by Anesthesia Technique: General value codes > 0)

Exclusions

Age ≥ 18 years 

Success Criteria

Nitrous oxide was not administered during the induction period of anesthesia

Other Measure Details

Values for flows and inhalational agents will be assessed and considered as artifact if inside the following ranges:

  • Nitrous Oxide Flows: < 0.2 L/min
  • Nitrous Oxide Insp %: < 20%

*This measure will include valid MPOG cases defined by the Is Valid Case phenotype.

Risk Adjustment

Not applicable

Provider Attribution

Provider(s) signed in during the induction time period

MPOG Concept Used
  • 3225       Flows Nitrous Oxide (L/min)
  • 3250       Nitrous Insp %
MPOG Phenotypes Used
References
  1. Epa US, OAR: Understanding global warming potentials 2016 at <https://www.epa.gov/ghgemissions/understanding-global-warming-potentials>
  2. Andersen MPS, Nielsen OJ, Wallington TJ, Karpichev B, Sander SP: Assessing the Impact on Global Climate from General Anesthetic Gases. Anesthesia & Analgesia 2012; 114:1081
  3. Eisenkraft JB, McGregor DG: Waste Anesthetic Gases and Scavenging Systems 2013:pp 125–47 doi:10.1016/b978-0-323-11237-6.00005-4
  4. Feldman JM: Managing fresh gas flow to reduce environmental contamination. Anesth Analg 2012; 114:1093–101.
  5. McGain F, Muret J, Lawson C, Sherman JD: Environmental sustainability in anaesthesia and critical care. Br J Anaesth 2020; 125:680–92. 
  6. Greening the Operating Room at <https://www.asahq.org/about-asa/governance-and-committees/asa-committees/environmental-sustainability/greening-the-operating-room>.
  7. Varughese, Shane MD; Ahmed, Raza MD. Environmental and Occupational Considerations of Anesthesia: A Narrative Review and Update. Anesthesia & Analgesia: October 2021 - Volume 133 - Issue 4 - p 826-835.
Measure Authors
 Author  Institution
 Meridith Wade MSN, RN  University of Michigan
 Rob Coleman  University of Michigan
 MPOG Pediatric Subcommittee  
Measure Reviewer(s)
Next Review: 2025
 Date Reviewed  Reviewer  Institution  Summary  QC Vote
         
Version
Published: 2022
 Date  Criteria  Revision
10/18/22    Initial Publication