Needleless inhaled anesthesia with sevoflurane: Advantages of a simplified approach for children with spinal muscular atrophy undergoing intrathecal administration of nusinersen

Annalisa Salerno, Enzo Picconi, Orazio Genovese, Marco Piastra, Silvia Maria Pulitano', Federica Tosi, Aldo Mancino, Marika Pane, Roberto De Sanctis, Debora Carlini, Eugenio Maria Mercuri, Giorgio Conti

Research output: Contribution to journalArticle

Abstract

BackgroundIntrathecal nusinersen administration, a fundamental step in the treatment of spinal muscular atrophy, is challenging in children. AimsThis retrospective monocentric analysis of prospectively collected data evaluated the feasibility of needleless general anesthesia exclusively with sevoflurane, without imaging guidance, for children undergoing nusinersen administration in a 24-month period. MethodsClinical data included demographics, type of spinal muscular atrophy, presence and severity of scoliosis. Primary outcome was defined by the number of predefined sentinel adverse events related to anesthesia. Secondary outcomes were assessed by duration of the procedure, number of lumbar puncture attempts, and number of failures. Other measures included number and type of moderate, minor and minimal adverse events, as well as number and type of puncture-related adverse events. Results116 patients (mean age: 8.7 (SD 6.9) years; with scoliosis: 49.1%) underwent 250 lumbar punctures; two cases of prolonged desaturation, considered as sentinel adverse events, (0.8%) were recorded during anesthesia (primary outcome). None of the patients underwent orotracheal intubation nor required an unplanned admission in the Pediatric Intensive Care Unit. No patient required an unplanned or prolonged hospitalization after the procedure. Mean number of puncture attempts was 1.6 (SD 1.3), and mean duration of the procedure was 14.1 (SD 8.3) minutes. No failure in the drug administration occurred (secondary outcomes). ConclusionIn this single-center experience, needleless general anesthesia with inhaled sevoflurane without imaging guidance has been shown to be feasible for children with spinal muscular atrophy undergoing lumbar puncture for nusinersen administration.
Original languageEnglish
Pages (from-to)282-290
Number of pages9
JournalPaediatric Anaesthesia
Volume33
DOIs
Publication statusPublished - 2023

Keywords

  • inhaled anesthesia
  • lumbar puncture
  • nusinersen
  • pediatrics
  • spinal muscular atrophy
  • techniques

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