Clinical anesthesiology has gone through nearly 150 years of history, whether from the advancement of anesthesia concepts, methods and techniques, the elimination and selection of anesthesia drugs, the updating and development of anesthesia equipment, and the changes in disease types and patients’ physique, modern anesthesiology has presented changes that could not be matched in the past: for example, real-time and fine monitoring equipment; for example, highly controllable drugs; for example, globally shared information ……. Even so, there are still anesthesia-related accidents that occur. Some of the causes are avoidable and some are unpredictable, including technical errors, proper drug administration, equipment failure, complexity of the condition, and differences in the perception of risk ……. The question of how to maximize the safety and quality of anesthesia is still a problem worldwide. The safety of anesthesia is first and foremost related to the preoperative state of the patient. Since the 1960s, anesthesiologists have been using a criterion to assess the preoperative status of surgical patients: the ASA physical status classification. This standard classifies preoperative patients into 5 classes: class 1 is normal and healthy; class 2 is with mild systemic diseases, both of which can tolerate anesthesia well, with anesthesia accident rate less than 0.2%; class 3 refers to those with more serious systemic diseases, manifesting as limitation of daily activities, but not loss of life and work ability, and these patients have some risk to tolerate anesthesia, but after adequate preparation and active The incidence of anesthesia accidents is about 2%; level 4 refers to patients with serious systemic diseases, loss of ability to work and live, and frequent life-threatening conditions, and level 5 refers to patients who have difficulty in surviving 24 hours whether or not they undergo surgery, and these two types of patients are at great risk of anesthesia, and the incidence of anesthesia accidents is close to 10%. In addition to patient factors, the size of the procedure also determines the magnitude of the surgical risk. High-risk surgeries include aortic or large-vessel surgery, emergency surgery, medium- or large-sized surgery, prolonged surgery, and surgery with significant blood and fluid loss; moderate-risk surgeries include thoracic and abdominal surgery, brain, ENT, orthopedic, and pelvic surgery; and plastic surgery, ophthalmology, endoscopic surgery, and body surface surgery are all low-risk surgeries. There are several factors that are important in the selection of anesthesia. For example, whether the timing of anesthesia is appropriate: like coronary patients who have had myocardial infarction or frequent episodes of angina within 3 months should postpone elective surgery because the possibility of re-infarction in such patients is 20% to 35%, and the mortality rate can reach 15% to 30% if an infarction occurs in the perioperative period. Of course, in case of emergency surgery, a specific analysis should be made on a case-by-case basis as to whether the surgery should be performed. Different patients should also choose different methods of anesthesia: for example, patients in shock are in principle best not to use intravertebral block anesthesia. Anesthesiologists should understand the patient’s condition and the complexity of the operation in detail before anesthesia, correctly estimate the possible problems and develop solutions, while the awareness of crisis and precaution and responsibility in anesthesia may be even more important. There are many surgical and anesthetic factors that may also lead to anesthesia accidents. For example, mistaken insertion of a tracheal tube into the esophagus, large amounts of local anesthetics into the bloodstream, etc. Problems in anesthesia management may include improper transfusion of blood and fluids, drug accumulation, circulatory disturbances due to change of position, and lack of effective monitoring tools. Human errors may also lead to anesthesia accidents: e.g., wrong drug dosage, wrong anesthesia machine connector, wrong blood transfusion, equipment malfunction, etc. There are some uncontrollable causes that are often more serious: for example, some patients with special physiques present unpreventable dangers such as malignant hyperthermia, for example, amniotic fluid embolism during cesarean delivery. It should be said that modern medicine, despite its continuous improvement, cannot be denied that it still has limitations. The occurrence of anesthesia accidents is unfortunate, but each accident should be a stepping stone to medical progress, carrying a more perfect future for medicine. The safety of anesthesia is directly related to the success or failure of surgery, which is not only related to the ability and responsibility of anesthesiologists, but also closely related to the overall level of medical care in our society and the level of awareness of those who seek medical care.