Anesthetic practice in Japan: past, present, and future.

Significant progress has been made over the past 20 years in the development of anesthetic agents and anesthetic monitors. Due to progress in the development of medical devices and the establishment of an effective medical system, advanced age alone is no longer a contraindication for surgery. However, despite approval of the volatile anesthetic sevoflurane, Japan is lagging behind other developed countries with regard to anesthetic agents. The ultrashort-acting opioid analgesic remifentanil has finally become available in Japan, and the fast-onset neuromuscular blocking agent rocuronium is expected to be approved soon. Patient recruitment for phase III clinical trials using sugammadex, a selective reversal agent for rocuronium and vecuronium, has been completed in all countries, including Japan. In this article, changes in anesthesia over the past two decades are described and possible future changes in anesthesia in Japan are discussed.