Magnitude and Associated Factors of Oxygen Desaturation during Rapid Sequence Induction and Intubation at Saint Paul Hospital Millennium Medical College

Abstract

Abstract Background: Rapid sequence induction and intubation (RSII) involves administering a potent induction agent followed by a fast-acting neuromuscular blocker. This procedure rapidly induces unconsciousness and motor paralysis to facilitate tracheal intubation, especially in patients at risk of pulmonary aspiration. Although RSII complications are well documented in high-income settings, evidence from Ethiopian hospitals particularly from major referral centers such as SPHMMC is still limited. This study aims to address this gap, providing locally relevant evidence to inform clinical practice at SPHMMC and similar low-resource settings with limited access to advanced airway management tools. Objective: To assess the magnitude and associated factors of oxygen desaturation during Rapid Sequence Induction and Intubation at Saint Paul Hospital Millennium Medical College. Method : An institution-based cross-sectional study was conducted between October 1,2025 and January 31, 2026, at Saint Paul Hospital Millennium Medical College, focusing on patients undergoing rapid sequence induction and intubation. After pre-testing a structured quantitative tool, it was applied on 389 patients undergoing elective and emergency surgery using interviewer-administered structured questionnaire. Data was checked, coded, entered and analyzed in SPSS V-25. Descriptive statistics was presented using text, figures and tables. The association between variables was analyzed with bivariate and multivariable logistic regression. Statistical significance was declared at a p-value < 0.05, with a 95% confidence interval. Result: A total of 377 patients were included (response rate 96.9%), with a mean age of 36.38 ± 15.65 years. The magnitude of oxygen desaturation during rapid sequence induction and intubation (RSII) was 7.4%. In multivariable logistic regression analysis, history of smoking (AOR=6.28, 95% CI (1.70-13.14)), pre-oxygenation performed (AOR=0.11, 95% CI (0.02-0.53), and number of laryngoscope attempt (AOR=4.22, 95% CI (1.02-17.36)) were significantly associated with oxygen desaturation during RSII (p < 0.05). Conclusion: The magnitude of oxygen desaturation during RSII was 7.4%. History of smoking, pre-oxygenation performed and number of laryngoscope attempts were significantly associated with desaturation. Strengthening adherence to standardized airway preparation protocols and minimizing repeated laryngoscopy attempts may help reduce oxygen desaturation during RSII.