Sustainability in healthcare is a big challenge.
But not every opportunity to reduce environmental impact has to begin with a big change.
Sometimes it starts by looking more closely at the everyday processes behind care. In other words: what we use, how we use it and, importantly, what we don’t use.
Nitrous oxide is one example.
Nitrous oxide and a greener NHS
The NHS has committed to reaching net zero by 2040 for the emissions it controls directly, and by 2045 for those it can influence.
That means looking across everything from buildings and transport to medicines, equipment and clinical practice. And nitrous oxide is firmly on the agenda.
NHS England identifies nitrous oxide as a significant contributor to emissions from anaesthetic and medical gases, with current Green Plan guidance specifically calling on trusts to reduce nitrous oxide waste.
This isn’t simply a future ambition. Work is already happening across the NHS to identify where Nâ‚‚O is being wasted and how that waste can be reduced.
Dental sedation presents a particularly interesting opportunity.
What happens to the gas we don’t use?
Nitrous oxide remains a valuable form of conscious sedation in dentistry.
In standard UK inhalation sedation, a mixture of nitrous oxide and oxygen is typically delivered using a continuous flow of gas, with the flow rate controlled by the clinical team.
But the patient isn’t continuously inhaling.
That raises a simple question: how much gas is being delivered that the patient doesn’t actually need?
New research published in the British Dental Journal in August 2026 examined exactly that. Researchers at Eastman Dental Hospital, part of University College London Hospitals NHS Foundation Trust, compared three approaches to inhalation sedation across 98 episodes of patient care: existing practice, a lower-flow technique and eAdvantage® demand-driven delivery.
The results were significant.
70% less nitrous oxide
Compared with existing practice, eAdvantage reduced the volume of nitrous oxide used per patient by 70% during the study.
Crucially, the success rate remained 97%, the same as existing practice within the study.
Rather than maintaining a continuous flow, eAdvantage releases gas on demand at the volume of each patient’s breath. The principle is straightforward:
- Deliver the gas when it’s needed. Don’t deliver it when it isn’t.
Wider UK clinical reference data supplied to Agile shows an average 69% reduction in N₂O consumed per session, with estimated annual savings of 1.2–2.4 tonnes of CO₂e per device, depending on use.
It is a good example of how looking differently at an established clinical process can uncover an opportunity to reduce waste.
Sustainability still has to work for care
Reducing environmental impact matters. But healthcare design can’t consider sustainability in isolation.
Any change to an established clinical process still has to work for the patient, the clinician and the environment in which care is being delivered. That’s particularly important with conscious sedation.
In the Eastman study, researchers didn’t assess gas consumption alone. They also considered treatment success and gathered feedback from patients and clinical staff.
Patient feedback on the two alternative techniques was largely positive. Both dentists and dental nurses expressed a preference for eAdvantage, with staff highlighting its breathing monitoring and automatic electronic features. The study also identified practical challenges, including achieving an adequate seal around the nasal mask in some cases.
That matters. Because better environmental performance is only meaningful in healthcare when the solution continues to support effective care.
Doing more by wasting less
There is no single answer to making healthcare more sustainable. Nor should one technology be presented as one.
But reducing unnecessary consumption is a logical place to look. The authors of the Eastman study make a similar point through the established waste hierarchy: preventing waste should be prioritised ahead of trying to capture, recover or dispose of it afterwards.
Their findings support techniques that reduce or eliminate continuous gas flow as one way of mitigating the environmental impact of Nâ‚‚O in dental settings.
For dental sedation, that asks us to think not only about which gas is being used. But when it is being delivered, how much is needed and what happens to the rest. Sometimes more sustainable care starts there.
Demand-driven delivery in practice
eAdvantage® is a demand-driven inhalation sedation system manufactured by O-Twoâ„¢ Medical Technologies. Instead of continuously releasing gas at a set flow rate, the system synchronises delivery with the patient’s breathing, releasing gas on inhalation.
Agile is the exclusive UK distributor of the O-Two™ eAdvantage® system.