Tamimi [1] have presented a thorough review of 92 patients having cataract surgery under general anesthesia, emphasizing that despite the significant pre-existing medical ailments of many of these patients, none experienced mortality or significant morbidity from general anesthesia. These results are reassuring to those of us who are, at times, hesitant to utilize general anesthesia for such patients, but feel compelled to do so because of the patient's inability to lie flat or because of a communication barrier between the patient and anesthesiologist. However, I point out another