Dr. Cherine El-Dabh, MD

Before surgery, you'll have a talk with the anesthesiologist to go over some basic info. Be certain that you have that chat and that you're wholly forthcoming with this doctor. You need to meet the anesthesiologist face to face and give him or her some dirt, including the last time you had general anesthesia, exactly how much you drink, what drugs you use and how often.

People who use substances recreationally can keep their habit hidden from lots of people, but they'd better be upfront with the anesthesiologist because narcotics and other drugs can increase tolerance to sedation (and you don't want to be wide awake when the surgeon asks for the knife).

The anesthesiologist also needs to know how much you exercise, any allergies you have, and every medication and herbal supplement you take.

The concept of anesthesia has been around since people first began performing surgery -- no matter how primitive or crude. The first anesthetics were soporifics (which dull senses and induce sleep) or narcotics (including opium, mandrake, jimsonweed, marijuana, belladonna and alcohol). Native American cultures, such as the Incas, chewed coca leaves (where cocaine is derived). All of these substances provide some level of pain relief, amnesia or sedation – but there were no guarantees. Beyond these, nonmedical methods have included ice (to numb the area), hypnosis and acupuncture.

By the mid-1840s, industrialized countries regularly used two anesthetic agents -- opium and alcohol. Both had many side effects and neither could dull pain completely. Doses large enough for the desired effect could result in death. Sometimes, a blow to the head was used to knock patients unconscious. Regardless of these methods, surgery typically resulted in the tortured screams of patients.

In 1846, everything changed. At Massachusetts General Hospital, a dentist named Dr. William Morton demonstrated the removal of a tumor from the jaw of a patient. Before operating, he used an ether-soaked sponge to render his patient unconscious. When the patient awoke, he claimed he had no memory of the operation and felt no pain. Doctors witnessing this event were highly skeptical. Soon, however, Morton was hailed as the conqueror of pain.

Unfortunately for Morton, he wasn't the only person to claim discovery of modern relief for surgical pain. After medical journals wrote about Morton, Dr. Crawford Long claimed he had first used ether during operations in 1841. Long said he noticed its effects after observing recreational users. Also, Dr. Charles Jackson claimed his work had influenced Morton. Jackson went to Congress in an attempt to gain recognition -- and he had the support of Oliver Wendell Holmes (credited with first suggesting the word 'anesthesia').

In 1845, Dr. Horace Wells used nitrous oxide when pulling teeth. About the same time, the first use of chloroform as an anesthetic was used by Dr. James Simpson. Because of its high toxicity, ether replaced chloroform by the early 1900s.

Derivatives of some of these early substances are still in use, including nitrous oxide, morphine and the "-aine" drugs chemically related to cocaine.

One of the greatest and safest aspects of cataract surgery is that it is painless and is performed with the patient awake in almost all cases. There is no pain and it is safe without general anesthesia.