Eliminating Nitrous Oxide and Advancing Sustainable Care in the OR with Dr. Arash Motamed

Dr. Arash Motamed, Anesthesiologist and Medical Director of Sustainability at Keck Medicine of USC, shares his groundbreaking initiative to eliminate nitrous oxide (laughing gas) from anesthesia delivery across two of his institution's hospitals. What began as a casual conversation about nitrous oxide's environmental impact—specifically its 75-95% leakage rate into the atmosphere, potent greenhouse effect (300x CO2), ozone depletion, and 100-year atmospheric lifetime—spurred a multi-year effort to phase it out entirely. Through collaborative stakeholder engagement, education, and strategic problem-solving (including working with equipment manufacturers to bypass machine self-check errors and using nitrogen to preserve pipelines instead of decommissioning them), Keck Medicine became the first U.S. institution to fully remove nitrous oxide from both central pipelines and backup cylinders. Remarkably, not a single emergency request was made for nitrous oxide in three years at Keck Hospital and two years at Norris Cancer Hospital, proving clinical safety and feasibility. Dr. Motamed emphasizes that sustainability in healthcare isn't just an environmental imperative but a core component of value-based care—where reducing waste, emissions, and resource use aligns with better patient outcomes, cost efficiency, and operational excellence. He highlights the untapped potential in clinician education and cross-functional collaboration as the key to scaling similar initiatives across health systems.