Introduction:
Diagnostic muscle biopsy is a procedure performed to investigate myopathic and neurodegenerative diseases. The choice of anesthetic technique and agents must consider the patient’s specific risks and the type of muscle biopsy specimen. Here, we discuss the various considerations for anesthesia during muscle biopsy.
Table 1: Types of Muscle Biopsy Specimens
| Type of Muscle Biopsy Specimen | Considerations |
|---|---|
| Standard Anatomical Muscle Biopsy | No specific anesthetic requirements |
| Contracture Test | Non-triggering anesthetic to avoid MH episode and contracture test effects |
| Mitochondrial Enzyme Analysis Biopsy | Considerations include avoiding propofol, but all anesthetics can affect enzyme assays |
Preanesthesia Assessment:
The preanesthesia assessment for muscle biopsy follows a similar approach as for all patients with myopathies.
Table 2: Choice of Anesthetic Technique for Muscle Biopsy
| Anesthetic Technique | Considerations |
|---|---|
| Regional Anesthesia | Suitable for cooperative adults and older children |
| Spinal anesthesia may be used for infants below 5 kg and mature young adults, but it’s technically challenging | |
| Local anesthetic infiltration can be used for older children | |
| Local anesthesia may risk contaminating the specimen in very small children | |
| General Anesthesia | Required for children and patients with developmental disabilities |
| Optimal choice of agents debated, considering undiagnosed myopathy | |
| Anesthetic requirements differ based on the likely diagnosis (see next section) |
Table 3: Anesthetic Considerations Based on Likely Diagnosis
| Likely Diagnosis | Anesthetic Considerations |
|---|---|
| Patients at risk for Malignant Hyperthermia (MH) | Non-triggering anesthetic to avoid MH episode |
| Avoid succinylcholine and volatile inhaled anesthetics | |
| Use an anesthesia machine cleaned of inhalation agents | |
| Patients at risk for Anesthesia-Induced Rhabdomyolysis | Non-triggering anesthetic to avoid rhabdomyolysis |
| Avoid succinylcholine and volatile inhaled anesthetics | |
| Use an anesthesia machine cleaned of inhalation agents | |
| Metabolic Myopathy Suspected | Volatile anesthetics may be used, anticipating increased sensitivity |
| Avoid propofol due to a small, unquantifiable risk of propofol infusion-like syndrome | |
| No Clear Suspected Diagnosis | Avoid volatile inhaled anesthetics and use intravenous (IV) anesthesia with or without nitrous oxide |
| Regional anesthesia may be considered if appropriate |
Conclusion:
Anesthesia for diagnostic muscle biopsy involves a thoughtful assessment of the patient’s risks and the type of biopsy specimen. The choice between regional anesthesia and general anesthesia, as well as the selection of anesthetic agents, should be based on the likely diagnosis and patient-specific considerations.
This article summarizes the key points related to anesthesia for diagnostic muscle biopsy and presents the information in a structured format with tables for easy reference.
