Laryngeal microsurgery under deep neuromuscular block

INTERVENTION: Patients are randomized in two group using minimization For both groups patients are in dorsal position with classical monitoring. Preoxygenation Local of glottis 2mg/kg lidocaine Ventilation with high frequencies jet ventilation driving pressure between 1.5 and 3 bar, respiratory rate 150/min and report I/T 30% Surgeons will not be aware of the group to which the patient belongs. Automatic and continuous recording of vital parameters by Philips monitoring. In particular, monitoring of neuromuscular function by the NMT module (Acceleromyography by hand with TOF‐tube: calibration, supra‐maximal stimulation of the ulnar nerve by train‐of‐four (TOF) every 15 seconds and recording of muscle responses in the protocol of anesthesia according to the recommendations of the literature Group non curare, anesthesia induction 1. lidocaine 1mg/kg intravenous bolus 2. remifentanyl 0.5 µg/kg/min at the start and 0.15 µg/kg/min during the surgery continuous intravenous 3. propofol mode Target controlled intravenous anaesthesia to adapt according to the depth of anesthesia 4. solumedrol 2mg/kg bolus intravenous After the disappearance of the ciliary reflex and spontaneous ventilation, an assisted manual ventilation test is performed: The patient is manually ventilated until it is deep enough. Bi‐spectral index <60. Placement of eye protection. The surgeon exposes the glottal in apnea and evaluates its facility: easy, difficult or inexposable + duration of installation and his vision of vocal cords: o, ¼ post, ½ post, ¾ post or entire. With the installation of the laryngoscope performed, the surgeon places the Mayne‐Remacle metal catheter in infraglottic and the high frequency type ventilation starts: The quality of the operating conditions will be evaluated from the first visualization of the operative field and every 5 minutes in different ways: ‐ Evaluation of the operating conditions by the surgeon (4 grades excel CONDITION: Anaesthesiology ‐ Anaesthetics neuromuscular relaxation;microsurgery of vocal cord.; ; neuromuscular relaxation ; microsurgery of vocal cord. Surgery ‐ Other surgery PRIMARY OUTCOME: The number of patients passing from the group without curare to the group curare[at every moment during the surgery, if surgical conditions become inacceptable.] SECONDARY OUTCOME: Cough, visual diagnosis by the surgeon[every 5 minutes intraoperatively] objective surgical conditions. it's the distance between the vocal cords at the anterior and posterior commissures is measured with a calibrator ; The calibrator is a palpator for vocal cords who measures 5 mm.[every 5 minutes intraoperatively] subjective surgical conditions with a scale (excellent‐acceptable‐to improve‐inacceptable) ; [every 5 minutes intraoperatively] the duration of glottic exposure in second with a stopwatch[During the glottic exposure] the duration of the surgery in minute with a stopwatch[all surgery] the easy of glottic exposure with scale ( easy, moderate, difficult and inexposable)[During the glottic exposure] the recovery time of a spontaneous breathing in minute and second with a stopwatch[the recovery phase] vocal cords movement, visual diagnosis by the surgeon[every 5 minutes intraoperatively] INCLUSION CRITERIA: Patients for laryngeal micosurgery