New evidence indicates that the use of 'cracking' technology can significantly reduce the ambient levels of inhaled N2O during labor, especially when women are coached on how best to use it. MedTwitter greenanesthesia QualityImprovement
Proportionally, the United Kingdom is one of the largest users of inhaled N2O during labor, often for first-line pain control. A 2017 survey by the Care Quality Commission estimated that 77% of women in labor used inhaled N2O for pain, and that it didn't preclude them from using other types of analgesia, including opioids, epidurals, and nonpharmacologic approaches.
"Given that a similar magnitude of reduction in nitrous oxide levels was seen with mouthpieces and low-profile face masks, we suggest that pregnant women should be offered the option of either device when cracking is used," the study authors wrote. "Although cracking may make nitrous oxide ‘greener,' it does not make it ‘green,'"noted Pinder and coauthor Cliff Shelton, MBChB, in an interview. Shelton is a senior clinical lecturer in anesthesia at Lancaster University and a consultant anesthetist at Wythenshawe Hospital, Manchester.
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