Anesthesia for Diagnostic Muscle Biopsy


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 SpecimenConsiderations
Standard Anatomical Muscle BiopsyNo specific anesthetic requirements
Contracture TestNon-triggering anesthetic to avoid MH episode and contracture test effects
Mitochondrial Enzyme Analysis BiopsyConsiderations 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 TechniqueConsiderations
Regional AnesthesiaSuitable 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 AnesthesiaRequired 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 DiagnosisAnesthetic 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 RhabdomyolysisNon-triggering anesthetic to avoid rhabdomyolysis
Avoid succinylcholine and volatile inhaled anesthetics
Use an anesthesia machine cleaned of inhalation agents
Metabolic Myopathy SuspectedVolatile anesthetics may be used, anticipating increased sensitivity
Avoid propofol due to a small, unquantifiable risk of propofol infusion-like syndrome
No Clear Suspected DiagnosisAvoid volatile inhaled anesthetics and use intravenous (IV) anesthesia with or without nitrous oxide
Regional anesthesia may be considered if appropriate


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.


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