Oscar Duffy

BACKGROUND Climate change has emerged as the single biggest global health threat of the twenty-first century. Nitrous oxide accounts for the largest carbon footprint amongst our use of anaesthetic gas. It is a potent greenhouse gas possessing a global warming potential of approximately 265 times that of carbon dioxide. Despite recent curtailment of its use, it remains extensively employed as an analgesic for women in labour. OBJECTIVES Assessment of the opinions of post-natal women and staff on nitrous oxide use and to investigate whether knowledge of its environmental harm would influence their choice of labour analgesia. DESIGN Postnatal women and healthcare staff were invited to participate in a survey of nitrous oxide use as a labour analgesic and knowledge of its effect of the environment. SETTING A single-centre study in a major obstetric tertiary referral centre in Ireland in 2021. MAIN OUTCOME MEASURES To evaluate the awareness and perceptions of postnatal women and staff regarding the environmental impact of nitrous oxide and if it would affect their decision to use it in the future. RESULTS One hundred postnatal women and 50 healthcare staff completed the survey. One hundred and six post-natal women were invited to complete the survey, resulting in a response rate of 94%. Knowledge of nitrous oxide's environmental impact was low. After receiving information, 46% of patients were more inclined to seek epidural or request it earlier (54%) to limit their nitrous oxide use, while 51% would choose an alternative analgesia to avoid nitrous oxide altogether. Overwhelmingly, 99% believed they had the right to know about these harmful effects when choosing an analgesic option. CONCLUSIONS Patients should be informed of the environmental impact of nitrous oxide antenatally, empowering them to make informed decision on a climate friendly analgesic option if they wish.

The management of intracranial malignancies in pregnancy poses unique challenges to the perioperative team. We describe the successful surgical management of a meningioma in a 28-year-old previously healthy patient, in her third trimester of pregnancy, who first presented with a generalised seizure. Without clear guidelines on the management of intracranial malignancies in pregnancy, a multidisciplinary approach was essential in providing a management plan for the patient's seizures and on the timing of her surgical intervention. Hormone-mediated tumour growth was a significant factor in opting for urgent surgical intervention and we discuss the current evidence linking hormones to tumour growth in pregnancy.