A needleless general anesthesia is feasible in children with spinal muscular atrophy (SMA), according to a new study published in the journal Pediatric Anesthesia. The anesthesia, which consists of inhaled sevoflurane, does not require imaging guidance and has the advantage of being a simplified approach for children with the disease undergoing lumbar puncture for the administration of nusinersen.

A lumbar puncture is a crucial step for the intrathecal administration of nusinersen to treat patients with SMA, the researchers noted. However, it can be challenging, especially in children with the disease, they added.

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Here, a team of researchers led by Giorgio Conti, MD, from the Pediatric Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS in Rome, Italy, explored the feasibility of needleless general anesthesia exclusively with sevoflurane and without imaging guidance in children with SMA.

The researchers analyzed 116 patients who underwent 250 lumbar punctures following needleless anesthesia. Of these 116 patients, almost half (49.1%) had scoliosis. 

Only 2 patients had prolonged desaturation during anesthesia, and none had to undergo orotracheal intubation or required an unplanned admission to the intensive care unit. Similarly, none of the patients needed to stay in the hospital longer than planned.

The mean number of puncture attempts following needleless anesthesia was 1.6, while the mean duration of the procedure was 14.1 minutes. Failure in drug administration following this type of anesthesia did not occur in any of the patients.

Nusinersen, marketed under the brand name Spinraza® is a disease-modifying treatment for SMA. It consists of an antisense oligonucleotide designed to increase the production of SMN protein, which is deficient in SMA, from the SMN2 gene. Because nusinersen cannot cross the blood-brain barrier, it has to be administered intrathecally.

Sevoflurane is a sweet-smelling inhaled anesthesia approved by the US Food and Drug Administration for the induction and maintenance of general anesthesia in children and adults.


Salerno A, Picconi E, Genovese O, et al. Needleless inhaled anesthesia with sevoflurane: advantages of a simplified approach for children with spinal muscular atrophy undergoing intrathecal administration of nusinersen. Pediatr Anaesth. Published online January 13, 2023. doi:10.1111/pan.14630