Abstract: Entonox (N₂O) is a widely used and effective analgesic, particularly valued for its role in supporting women during labour. However, its use has significant environmental and occupational health implications. Nitrous oxide is a potent greenhouse gas with a global warming potential 298 times that of CO₂, and it remains stable in the atmosphere for up to 115 years. It is exhaled almost entirely unchanged, contributing substantially to climate change. Additionally, Entonox poses occupational risks to healthcare staff, including associations with miscarriage and B12 deficiency. A considerable proportion of Entonox is wasted due to leaks in pipework and bedhead connections. Even with a functioning demand valve, leakage can reach 2 litres per minute, while faulty valves may leak even more, often silently and unnoticed. Method: A multidisciplinary team, including an anaesthetist, estates manager, pharmacist, and obstetrics and gynaecology trainee, collaborated to address Entonox wastage. Initial tests identified and rectified leaks in the pipework system. Subsequently, the focus shifted to encouraging staff to unplug Entonox connectors at the bedhead when not in use. Visual remi
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