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still prefer general anesthesia as a standard technique for cesarean section. In addition, several studies reporting the use of general anesthesia for cesarean section are submitted to the Journal of Anesthesia from these countries [5, 6]. The increased rate of use in developing countries may be explained by their strict indications for cesarean sections. In addition, their limited medical resources and insufficient medical education may play a role. In contrast to the status in these developed and developing countries, the current status of general anesthesia for cesarean section in Japan remains unclear [7]. First, it should be noted that obstetricians manage anesthesia in >50 % cases and it is natural that they opt for spinal anesthesia. On the other hand, some anesthesiologists who participate in cesarean sections prefer general anesthesia. This may be explained by several reasons, such as a lower medical fee for spinal anesthesia than for general anesthesia, the lack of popularity of epidural analgesia during labor, and the underdevelopment of subspecialty education in the field of obstetric anesthesia. As a result, the rate of general anesthesia use for cesarean section remains relatively high in Japan compared with that in other developed countries. However, it is interesting to note that no case of anesthesia-related maternal death has been identified in a national survey of the causes of maternal death since 2010; this implies the need to revaluate the validity of the above-mentioned dogma. 2. Should efforts to avoid general anesthesia for cesarean sections continue? In 2011, Hawkins et al. [8] updated their previous study and reported that the case fatality rate for general anesthesia for cesarean section decreased dramatically from 16.8 per million in 1991– 1996 to 6.5 per million in 1997–2002, whereas that for There is a common saying that truth never grows old. In the field of obstetric anesthesia, however, several truths have become old over the past decade [1]. For example, ephedrine is no longer the first-line treatment for hypotension after spinal anesthesia for cesarean section, and spinal anesthesia is no longer contraindicated in patients with pre-eclampsia. On the other hand, the dogma that ‘general anesthesia for cesarean section is riskier than neuraxial anesthesia and should be avoided’ has been a firm belief to date, but the survival of this dogma for another decade is questionable.

When was the last time you induced general anesthesia for cesarean section?