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Robotic stereotactic radiosurgery using devices such as the CyberKnife® allows surgeons to treat tumours hitherto considered inoperable.

Some of these radiosurgery sessions can be performed without anaesthesia, but in some circumstances sedation or general anaesthesia is required to ensure the patient remains immobile and tolerates the supine position during the procedure.

In the stereotactic radiosurgery room, the anaesthesiologist must ensure, among other things, that the airway is patent, remote monitoring has been started, the patient is haemodynamically stable, anaesthesia is appropriate for a low-pain procedure, and the movement of the robotic arm is not obstructed.

Skeletal dysplasias involve major morphological changes.

General anaesthesia presents added risks of difficult intubation and early desaturation.

Spinal abnormalities cause difficulty in neuraxial techniques.

It is difficult to correctly titrate neuraxial anaesthesia in this population.

Preoperative anaesthesia evaluation and good planning is the key to success.