While the degree of cataract in this video is not so challenging, the actual surgery is very difficult due to the patient’s systemic condition of cervical dystonia where there is head movement throughout the procedure. The question is: What is your comfort level in dealing with this? If you have any uncertainty, then giving general anesthesia with systemic paralysis (such as with succinylcholine) may be the best option. If you think that, given your experience and skill set, some intravenous sedation (such as with midazolam) will be sufficient that you can spare the patient the additional risks. It really all depends on the surgeon’s judgment and I knew from previous cases like this, that we would be fine… as long as I remembered the one cardinal rule. Be super sweet to the patient and only give encouragement! Watch the video for the specific way that I do this. What would you choose for anesthesia in this case? Please comment below.