The Nitrous Oxide Project

nix the nitrous logoThis Nitrous Oxide project was started by Alifia Chakera, with support from CSH Fellows Chris Allen and Amarantha Fennell-Wells and The Association of Anaesthetists Environmental Champions. 

Nitrous oxide alone contributes 2% of the total NHS England carbon footprint, and 75% of the total anaesthetic gas footprint. For the NHS to achieve net-zero emissions by 2040, the carbon impact of nitrous oxide products needs to be tackled. 

Investigation by Alifia Chakera at NHS Lothian highlighted that a significant portion of nitrous oxide emissions are due to waste from manifolds and the associated piped infrastructure (1). The Nitrous Oxide Project is a way to centralise this work, promoting a lean methodology to identify system waste and improve medical gas management at acute sites. This project requires a multi-disciplinary team (MDT) approach, taking into account clinical use, product supply and total product turnover. Attached is an audit and analytics sheet to enable teams to investigate this easily.


  • Shortlisted for the Barema and Association of Anaesthetists award 2021
  • Shortlisted for the BMJ Environmental Award 2021 

Nitrous Oxide Infographics

Nitrous oxide infographicNitrous oxide infographic

Case Studies

nitrous oxide case study 1nitrous oxide case study 2nitrous oxide case study 3nitrous oxide case study 4nitrous oxide case study 5nitrous oxide case study 6

For more information:

If you’re interested in registering a project that you’ve started or would like some support with how to get going, please view our associated resources and then fill out this form.


Chakera, A. (2020) Reducing the Impact of Nitrous Oxide Emissions within Theatres to Mitigate Dangerous Climate Change. Evidence-Based Policy Brief Dissertation. University of Edinburgh