In no surgical arena is the cooperation and mutual understanding of the anesthesiologist and surgeon more important than in endolaryngeal surgery; here in the narrowest part of the airway, they compete for a share of the limited space available! The anesthesiologist must understand the requirements for optimal operating conditions but more importantly, the surgeon must understand the requirements for safe general anesthesia if unnecessary complications are to be avoided. Cardiac infarction, myocardial ischemia and arrhythmias, may occur during or after microsurgery of the larynx; they are most likely to be precipitated by pressure stimulation of the deep receptors of the larynx during suspension of the laryngoscope. The reflex pathway that produces the arrhythmia includes the superior laryngeal nerve and the cardio‐in‐hibitory fibers of the vagus. It appears that the complications are most often induced by the surgical manipulation and potentiated by abnormal blood gases. A small bore cuffed endotracheal tube appears to be an eminently satisfactory way of providing control of the airway and good operating conditions. The incidence of cardiac complications was studied in 540 patients and found to be 6.8 percent in the high risk group and 1.9 percent in the group without a preoperative history of cardiac disease. These figures are somewhat higher than those reported by Tarhan, et al., in their study of the incidence of myocardial infarction following surgery of various types under general anesthesia. To keep these complications to a minimum, constant vigilance must be maintained by the surgeon and anesthesiologist, especially on the cardiac monitor and airway. If arrhythmias appear, steps must be taken immediately to remove the cause, otherwise myocardial ischemia and infarction are very likely to follow.