To the Editor:

I would like to thank Dr. Fujita and his colleague for their comments [1] on my article “Rethinking general anesthesia for cesarean section” [2]. I will address each of his comments.

  1. 1.

    They state “there has not been a recent decline in educational opportunities regarding general anesthesia”. However, this was reported from the USA in 2000 [3], and has become a global concern. Hence, we hosted a JA symposium entitled “Rethinking general anesthesia for cesarean section” at the JSA annual meeting in 2014, and my article was written based on that symposium.

  2. 2.

    They state “the age range of 19–49 years is a very safe patient group” and claim that the problems of advanced maternal age are not significant. However, most parturients are in that range, and there is clear evidence of the hazards associated with advanced maternal age in that range [4].

  3. 3.

    They are not concerned about the obese parturient. However, there is clear evidence for the increased ratio of obese parturients and for the increased risk associated with obesity [5].

I published an editorial regarding these issues in 2015 [6]. However, it seems that further enlightenment activities are needed.