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, joins Mariah Taylor on the Becker's Healthcare Podcast to discuss his groundbreaking initiative to eliminate nitrous oxide (laughing gas) from hospital operating rooms. Motamed shares how a casual conversation with a colleague revealed the environmental toll of nitrous oxide—over 75% of it leaks into the atmosphere, where it acts as a potent greenhouse gas 300 times stronger than CO2 and depletes the ozone layer. Despite its clinical benefits like rapid onset and low cost, Motamed led a multi-year effort to remove nitrous oxide from both central pipelines and backup cylinders across two hospitals, becoming the first in the U.S. to fully decommission it. The transition required overcoming technical hurdles—such as anesthesia machine self-check failures—and building consensus among clinicians through education, surveys, and stakeholder collaboration. Remarkably, not a single emergency request was made for nitrous oxide in three years at Keck Hospital and two at Norris Cancer Hospital, proving the clinical viability of the change. Motamed emphasizes that sustainability in healthcare isn’t just about environmental impact but also aligns with better patient outcomes, cost efficiency, and value-based care. The episode highlights how sustainability initiatives thrive when clinicians, administrators, and facilities teams collaborate. Motamed identifies lack of education as the biggest barrier to progress, noting that once frontline providers are engaged, innovation becomes self-sustaining. He shares examples like repurposing pipelines with nitrogen and creating battery waste bins led by non-clinical staff. Success is measured not just by emissions reductions but by improved care delivery, reduced waste, and operational efficiency. The discussion underscores that sustainable healthcare isn’t a trade-off—it’s a pathway to better, more resilient, and more cost-effective care.