Colorado Anesthesia Services Group

Impact of Muscle Tremor on Surgery and Anesthesia

Muscle tremors are involuntary rhythmic contractions of various muscles in the body which have a constant frequency and amplitude (Agarwal & Biagioni, 2023). Tremors can pose significant challenges in the operating arena for both surgeons and anesthesiologists. Tremors can be induced by various conditions including fatigue, medications, or underlying medical conditions. Regardless of the scale of a procedure, muscle tremor can have profound effects on surgery precision, anesthesia management, and patient safety. It is important to consider and understand the impact of muscle tremors on outcomes and patient care (Verrelli, et al., 2016).  

Muscle tremors are particularly important in surgical procedures that require meticulous precision, including cardiac surgery, neurosurgery, and ophthalmologic surgery (Verrelli, et al., 2016). The fine motor skills that are required for these cases may be affected, compromising surgical accuracy. Furthermore, with the movement towards minimally invasive surgery, tremor effects may be amplified due to the laparoscopic instruments (Verrelli, et al., 2016). Surgeons must be prepared to anticipate and adapt to muscle tremor to compensate. This could involve slowing down their movements, using stabilizing devices, or employing robotic assistance and other technological aids.  

Anesthesia management plays a crucial role in mitigating the effects of muscle tremor during surgery. Anesthesiologists must carefully select and administer anesthetic agents to induce and maintain the appropriate depth of anesthesia and analgesia while minimizing the risk of intraoperative tremors and maximizing patient safety. It is vital that anesthetists closely monitor patient vital signs and neuromuscular function. Anesthesiologists must also be aware of medications that could cause tremor, including amiodarone, selective serotonin reuptake inhibitors, selective norepinephrine reuptake inhibitors, amitriptyline, lithium, valproate, beta-adrenoceptor agonists, dopamine receptor antagonists, VAMT2 inhibitors, or recreational drugs such as alcohol and cocaine. If a patient has a drug-induced tremor, it should resolve once the causative medication is stopped. However, it sometimes can be persistent (Baizabal-Carvallo & Morgan, 2022).  

Education and training are crucial components in managing muscle tremor during anesthesia and surgery. Surgeons and anesthesiologists must stay up to date on current research findings, emerging technologies, and best practices for tremor management. Simulation-based training program will offer valuable hands-on experience in navigating muscle tremor in surgical scenarios (Verrelli, et al., 2016). 

Ultimately, a multidisciplinary approach is crucial in addressing the impact of muscle tremors on surgery and anesthesia management. Close collaboration between the surgical team, anesthesia providers, and support staff is vital to optimize patient outcomes and ensure the safety and efficacy of procedures. By understanding the complexities of muscle tremor and implementing tailored strategies to manage them, healthcare professionals can enhance the quality of care provided to patients undergoing surgery.  


Agarwal, Shashank. and Milton C. Biagioni. “Essential Tremor.” StatPearls, StatPearls Publishing, 10 July 2023. 

Baizabal-Carvallo, José Fidel, and John C Morgan. “Drug-induced tremor, clinical features, diagnostic approach and management.” Journal of the neurological sciences vol. 435 (2022): 120192. doi:10.1016/j.jns.2022.120192 

Verrelli, David I et al. “Intraoperative tremor in surgeons and trainees.” Interactive cardiovascular and thoracic surgery vol. 23,3 (2016): 410-5. doi:10.1093/icvts/ivw150