Abstract
BACKGROUND: Nitrous Oxide (N(2)O) is a potent greenhouse gas with significant environmental impact and is currently the leading ozone depleting substance in use. Despite its long-standing role in anesthetic practice, data on N(2)O use and the environmental awareness of Brazilian anesthesiologists are scarce. This study aimed to describe patterns of N(2)O use and assess the level of awareness among anesthesiologists regarding its environmental impact. METHODS: A nationwide cross-sectional survey was conducted among anesthesiologists in a private Brazilian hospital network. The questionnaire addressed the frequency of N(2)O use in adult and pediatric anesthesia, knowledge of its environmental effects, and attitudes toward its continued availability. RESULTS: Of 1,238 eligible anesthesiologists, 941 completed the survey (response rate 76%). Overall, 59.3% (n = 558) reported never using N(2)O in adult patients, while 14.5% (n = 136) reported frequent or constant use. In pediatric patients, 27.5% (n = 259) reported never using N(2)O, and 38.9% (n = 366) reported frequent or constant use. Eighty percent (n = 753) indicated a reduction in N(2)O use since the beginning of their careers, and 34.5% (n = 325) were unaware of its contribution to climate change. Age and years of professional experience were directly proportional to N(2)O use in adults (p < 0.05), while awareness of its environmental impact was inversely associated with use in pediatric cases (p < 0.05). CONCLUSION: The survey demonstrates a shift toward reduced N(2)O use, particularly among younger anesthesiologists, although substantial use in adult practice remains. Persistent knowledge gaps highlight the importance of targeted education and policy interventions to mitigate environmental impact.