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stone island sale, which comprise banks of cylinders that supply piped N2O throughout the hospital to outlets that connect to anaesthetic machines (fig 1). Mechanisms of loss and waste of piped N2O include:Poor stock rotation resulting in unused cylinders being returned to the manufacturerOver ordering of N2O stock resulting in expired cylinders being returned to the manufacturer and vented to the atmosphereLeaking outlets or pipeworkTheft N2O has a street value and is at risk of theft if not tracked and secured adequately.Mixed N2O can be supplied by manifolds to wall outlets or gas blenders for procedural sedation or labour analgesia. Similar principles can be applied to reduce loss of mixed N2O.Fig 1 Schematic of manifold supplying N2OEvidence for the solutionResearch carried out across 16 sites in Scotland in 2019/20 identified waste of N2O averaging 95% resulting from several of the above mechanisms of waste and loss.5 This led to the creation of the Nitrous Oxide Project which recommends a multidisciplinary approach to efficiently and systematically identify system waste and improve medical gas management 6 In NHS Lothianwho passes easily for straight and slides encounters with random rough trade carelessly into his schedule does not struggle with at all. To begin with
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