The incidence of oxygen desaturation during rapid sequence induction and intubation

doi:10.5847/wjem.j.issn.1920-8642.2014.04.007

Abstract

Abstract:

BACKGROUND: Rapid sequence induction and intubation (RSII) is an emergency airway management technique for patients with a risk of pulmonary aspiration. It involves preoxygenation, administration of predetermined doses of induction and paralytic drugs, avoidance of mask ventilation, and laryngoscopy followed by tracheal intubation and keeping cricoid pressure applied till endotracheal tube cuff be inflated. Oxygen desaturation has been seen during RSII. We assessed the incidence of oxygen desaturation during RSII.
METHODS: An institution-based observational study was conducted from March 3 to May 4, 2014 in our hospital. All patients who were operated upon under general anesthesia with RSII during the study period were included. A checklist was prepared for data collection.
RESULTS: A total of 153 patients were included in this study with a response rate of 91.6%. Appropriate drugs for RSII, equipments for RSII, equipments for difficult intubation, suction machine with a catheter, a monitor and an oxygen backup such as ambu bag were not prepared for 41 (26.8%), 50 (32.7%), 51 (33.3%), 38 (24.8%) and 25 (16.3%) patients respectively. Cricoid pressure was not applied at all for 17 (11.1%) patients and 53 (34.6%) patients were ventilated after induction of anesthesia but before intubation and endotracheal cuff inflation. A total of 55 (35.9%) patients desaturated during RSII (SPO₂<95%). The minimum, maximum and mean oxygen desaturations were 26%, 94% and 70.9% respectively. The oxygen desaturation was in the range of <50%, 50%-64%, 65%-74%, 75%-84%, 85%-89 % and 90%-94% for 6 (3.9%), 7 (4.6%), 5 (3.3%), 10 (6.5%), 13 (8.5%) and 14 (9.2%) patients respectively.
CONCLUSION: The incidence of oxygen desaturation during RSII was high in our hospital. Preoperative patient optimization and training about the techniques of RSII should be emphasized.

Key words: General anesthesia, Rapid sequence induction and intubation, Oxygen desaturation

Endale Gebreegziabher Gebremedhn, Desta Mesele, Derso Aemero, Ehtemariam Alemu. The incidence of oxygen desaturation during rapid sequence induction and intubation[J]. World Journal of Emergency Medicine, 2014, 5(4): 279-285.

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Factors	Frequency	%
ASA status
ASA1	124	81
ASA2	23	15
ASA3	5	3.3
ASA4	1	0.7
Type of operation
Elective	16	9.2
Emergency	137	89.5
Urgency of operation
Major	151	97.7
Minor	2	0.3
Surgical subspecialties
General & urology	109	71.2
Obstetric	19	12.4
Gynecology	5	3.3
Orthopedic	8	5.2
Ear, nose, neck, head, extremity	7	4.6
Presence of documented respiratory disease
No	148	96.7
Yes	5	3.3
History of documented cigarette smoking
No	152	99.3
Yes	1	0.7
Preoperative documented significant alcohol intake
No	141	92
Yes	12	7.8
Number of patients handled by the anesthetists with different qualifications
BSc	111	27.5
Msc	42	72.6
Number of patients handled by the anesthetist with different years of services
<1 Year	87	56.9
1-2 years	21	13.7
3-5 years	29	19
>5 years	16	10.5
Training about RSII after graduation
No	153	100
Yes	0	0
Patient position during induction of anesthesia
Supine	153	100
Lateral	0	0

Factors	Frequency	%
Presence of airway obstruction
No	153	100
Yes	0	0
Preoperative existed airway obstruction
No	153	100
Yes	0	0
Documented pre-induction desaturation
No	144	94.1
Yes	9	5.9
Preoperative OPV statues
OPV 1	125	81.7
OPV2	25	16.3
OPV3	1	0.7
Uncooperative	2	1.4
Appropriate drugs prepared RSII
Yes	112	73.2
No	41	26.8
Equipments for RSII prepared
Yes	103	67.3
No	50	32.7
Equipment for difficult intubation prepared
Yes	102	66.7
No	51	33.3
Suction machine with a catheter prepared
Yes	108	70.6
No	45	29.4
Appropriate monitoring prepared
Yes	115	75.2
No	38	24.8
Oxygen prepared
Yes	153	100
No	0	0
Oxygen backup prepared [ambu bag]
Yes	128	83.7
No	25	16.3

Factors	Frequency	%
Preoxygenation
Yes	153	100
No	0	0
Suction machine connected with catheter & turned on
Before induction	118	77.1
After induction	18	11.8
Not done	17	11.1
Landmark identification for cricoid pressure
Before induction of anaesthesia	90	58.8
After induction of anaesthesia but before loss of consciousness	32	20.9
After induction of anaesthesia and loss of consciousness	14	9.2
Not done	17	11.1
Qualification of assistance who applied cricoid pressure
MSc	17	11.1
BSc	55	35.9
3^rd year	22	14.4
4^th year	27	17.6
Others	15	9.8
Not done	17	11.1
Number of laryngoscopy attempts during RSII
1	140	91.5
2	10	6.5
3	3	2
Ventilate after induction, before intubation and endotracheal tube cuff inflation during RSII
No	100	65.4
Yes	53	34.6
Difficult intubation during RSII
No
Yes
Oxygen desaturation during RSII
No	130	85.0
Yes	23	15.0

Variables	Oxygen desaturation during RSII
Variables	No	Yes (n, %)
Urgency of operation
Emergency	114	23 (15)
Elective	16	0 (0)
Type of operation
Major	128	23 (15)
Minor	2	0 (0)
Seniority of anesthetist
MSc	36	7 (4.6)
BSc	94	16 (10.5)
Year of services of anesthetist
< 1 year	75	12 (7.8)
1-2 years	17	4 (2.6)
3-5 years	25	4 (2.6)
>5 years	13	3 (1.9)
Documented preoperative desaturation
No	125	19 (12.4)
Yes	5	4 (2.6)
Number of laryngoscopy attempts during RSII
1	122	18 (11.8)
2	6	4 (2.6)
3	2	1 (0.7)
ASA status
ASA1	105	19 (12.4)
ASA2	20	3 (1.9)
ASA3	5	1 (0.7)