Procedural Sedation for Pediatric Patients with Spinal Muscular Atrophy
Undergoing Intrathecal Treatment
Abstract
Aims: Nusinersen is administered intrathecally for treating spinal
muscular atrophy (SMA). Procedural sedation is common with intrathecal
treatment in children. This retrospective study presents our experience
with procedural sedation during the intrathecal treatment of pediatric
patients with SMA I, II, and III. Methods: Data were collected the from
the anesthesia charts and electronic medical records of 14 pediatric
patients with SMA types I, II, and III who underwent procedural sedation
for repeated intrathecal treatments for SMA. Intravenous induction was
performed, and patients were oxygenated with a face mask or nasal
cannula while spontaneous breathing continued. Results: Fourteen
patients were included in the study: one SMA I, eight SMA II, and five
SMA III. They underwent 88 intrathecal nusinersen injections totally. In
the one SMA I patient, of eight months, the procedure was performed
under local anesthesia. In all other patients, the treatments were
performed under procedural sedation. Different combinations of
midazolam, ketamine, propofol, fentanyl, and remifentanil were used. The
mean doses of the agents used were 0.03 mg/kg, 0.97 mg/kg, 2.71 mg/kg,
0.84 mcg/kg and 0.5 mcg/kg respectively. There were no intraoperative or
postoperative complications. Conclusion: We found the procedural
sedation to be sufficient, effective, and safe in SMA II and III
pediatric patients who underwent nusinersen treatment intrathecally,
provided anesthetic agents are titrated.and administered carefully.