Successful Spinal Anaesthesia for Gastrostomy Tube Placement in an Infant with Spinal Muscular Atrophy Type I: A Case Report

Introduction Spinal muscular atrophy (SMA) type I causes severe bulbar and respiratory muscle weakness, making general anaesthesia and postoperative ventilation potentially hazardous. Case Description A 12-month-old girl weighing 6.7 kg with genetically confirmed 5q SMA type I, chronic hypercapnic respiratory failure, and nocturnal bilevel non-invasive ventilation required open gastrostomy for progressive feeding failure. Spinal anaesthesia was performed at L4–L5 on the first attempt using a 25-gauge, 25-mm pencil-point needle and 5 mg (1 mL) of 0.5% hyperbaric bupivacaine. A bilateral T6 sensory block was established before incision. Spontaneous ventilation was maintained with oxygen at 1 L/min and continuous sidestream capnography. Surgery lasted 20 minutes and total anaesthesia time was 55 minutes. No conversion to general anaesthesia, vasopressor treatment, apnoea, or escalation of respiratory support occurred. Discussion Recovery was uncomplicated, with sensory and motor function returning to baseline. This case illustrates that, in carefully selected infants with severe SMA undergoing a brief open procedure, spinal anaesthesia may preserve spontaneous ventilation and avoid airway instrumentation when multidisciplinary planning, close monitoring, rescue airway capability, and postoperative observation are available.