Japan is challenged with unique social problems because of its declining birthrate and rapidly aging population. By the year 2025, all of Japan's baby boomers will be 75 years or older, making Japan a "superaging" society. Japanese healthcare expenditures are rapidly climbing because of the need for increasingly complex medical-surgical treatments for this aging population. In addition, a major shortage of anesthesiologists has produced serious threats to patient safety, as well as to quality and timeliness of surgical care. In an attempt to meet the demand for anesthesia services and to ensure access and quality care, the Japanese Ministry of Health, Labor and Welfare has identified a potential role for nurses as anesthesia practitioners, as an innovative solution. Nurse and physician educators in Japan have begun educating and training nurses in the practice of anesthesia; however, nationally recognized licensure or certification does not yet exist for graduates of these programs. The purpose of this article is to review the unique challenges facing Japan's anesthesia practice and to make recommendations about the potential introduction of nurse anesthetists in Japan.