La neurochirurgie stéréotaxique a trouvé un regain d’intérêt avec le développement des technologies modernes. Les pôles d’orientation actuels sont représentés par la stéréotaxie tumorale à visée diagnostique mais aussi thérapeutique, la stéréotaxie fonctionnelle surtout celle des mouvements anormaux sans oublier le traitement de certaines épilepsies réfractaires ou de certaines douleurs chroniques et la radiochirurgie stéréotaxique qui associe la méthodologie stéréotaxique à une irradiation externe. L’anesthésiste fait partie d’une équipe multidisciplinaire comprenant neurochirurgiens, neuroradiologues, neurologues, psychologues et radiothérapeutes. Les procédures de neurochirurgie fonctionnelle sont longues et spécifiques. La coopération transitoire du patient peut être souhaitée. Les médications anesthésiques doivent interférer le moins possible avec une électrophysiologie peropératoire si celle-ci est planifiée. L’anesthésie locale avec sédation est souvent utilisée. Cependant l’anesthésie générale est actuellement de plus en plus pratiquée, elle apporte confort et sécurité. Le réveil doit être rapide, prévisible et d’excellente qualité. Ces conditions font de l’association propofol en AIVOC et rémifentanil en perfusion continue une technique de choix.

Functional neurosurgery procedures are long and specific. Cooperation of the patient may be necessary during surgery. The interference of anaesthetic agents with electrophysiological monitoring should be as little as possible. Local anaesthesia combined with intravenous sedation is often used, but general anaesthesia is more comfortable and secure. Since awakening during the procedure is generally planed, it has to be quick, reliable and of excellent quality. These requirements are fulfilled by the association of propofol by target-controlled infusion (TCI) and a continuous infusion of remifentanil.

Functional neurosurgery procedures are long and specific. Cooperation of the patient may be necessary during surgery. The interference of anaesthetic agents with electrophysiological monitoring should be as little as possible. Local anaesthesia combined with intravenous sedation is often used, but general anaesthesia is more comfortable and secure. Since awakening during the procedure is generally planed, it has to be quick, reliable and of excellent quality. These requirements are fulfilled by the association of propofol by target-controlled infusion (TCI) and a continuous infusion of remifentanil. (C) 2002 Editions scientifiques et medicales Elsevier SAS.

To assess the reactivity of sarcoplasmic reticulum to caffeine, using the skinned muscle fibre tension test and to compare it with the reference in vitro contracture test in the diagnosis of malignant hyperthermia (HM) susceptibility.Laboratory investigation.Muscle biopsies from 63 patients, including 29 classified as susceptible to MH (MHS) and 34 classified as non-susceptible (MHN) according to criteria of the European and the North American MH groups.The reactivity to caffeine and halothane of skinned muscle fibres was compared, according to the type of fibres, with the data of the in vitro contracture test. The type of fibres (type I: oxidative, slow; type II: glycolytic, fast) were determined with strontium dose-response curves.The reactivity to caffeine was significantly lower in the MHS group, for both type I and type II skinned fibres. However, in comparison with the data of the in vitro contracture tests, using the ROC curve analysis, the best sensitivity-specificity compromise was 90%-71% and 74%-84% for type I and type II skinned fibres respectively.The skinned muscle fibre tension test cannot be used instead of the in vitro contracture test for the diagnostic of MHS. However, it may strengthen the data of the latter.

Objective: To assess the reactivity of sarcoplasmic reticulum to caffeine, using the skinned muscle fibre tension test and to compare it with the reference in vitro contracture test in the diagnosis of malignant hyperthermia (HM) susceptibility.Study designs Laboratory investigation.Materials Muscle biopsies from 63 patients, including 29 classified as susceptible to MH (MHS) and 34 classified as non-susceptible (MHN) according to criteria of the European and the North American MH groups.Methods The reactivity to caffeine and halothane of skinned muscle fibres was compared, according to the type of fibres, with the data of the in vitro contracture test. The type of fibres (type I: oxidative, slaw;type II: glycolytic, fast) were determined with strontium dose-response curves.Results: The reactivity to caffeine was significantly lower in the MHS group, for both type I and type II skinned fibres. However, in comparison with the data of the in vitro contracture tests, using the ROC curve analysis, the best sensitivity-specificity compromise was 90%-71% and 74%-84% for type I and type II skinned fibres respectively.Conclusion: The skinned muscle fibre tension test cannot be used instead of the in vitro contracture test for the diagnostic of MHS. However, it may strengthen the data of the latter. (C) 1999 Elsevier, Paris.