new therapeutic choices have been developed for hepatocellular carcinoma (HCC), including percutaneous ablation therapy, transarterial chemoembolization, radiation therapy and molecular target therapy. Ablation of liver tumors is currently the main alternative to formal liver resection. This work aimed at comparing percutaneous ethanol injection (PEI) with combined percutaneous ethanol and mitoxantrone injection (PIM) in treatment of HCC.Patients and methods: This study comprised of 125 patients with 131 HCC lesions which were randomly divided into two groups; group I composed of 68 lesions in 65 patients treated with PEI. Group II composed of 63 lesions in 60 patients treated with PEI and PIM. Clinical assessment, laboratory evaluation and CT studies were performed to all patients pre treatment and at 3, 6, and 12 months post treatment.Results: the percentage of ablation in both groups at 3, 6 , 12 months are 60.3% , 48.5% and 39.7% in group I respectively versus 85.5% , 74.6% and 68% in group II respectively with a significant difference between the two groups. There is an increased number of local recurrence in group I compared to group II. Side effects and complications are comparable in both groups.Conclusion: combination of PEI and PIM is better than PEI alone without additional complication and recurrence rate seemed to be better in combination therapy than PEI alone.Results: This study revealed that laryngospasm had the highest incidence of the anesthesia mishaps in Zagazig University Hospitals and occurred more in pediatric patient. Mishaps with general anesthesia has higher incidence involving 93% of the cases while mishaps with regional anesthesia was 7% of the cases. Airway mishaps have higher incidence including 23% laryngospasm, 14% airway injury, 2% unanticipated difficult airway, 3% endotracheal tube malfunction, 2% inadvertent oesophageal intubation and 1% endobronchial intubation. Intraoperative pain occurred in 13% of the cases due to lack of adequate analgesia intraoperatively. Mishaps with regional anesthesia represent 9% of the cases, slipped intravenous line and extravasation include 6% of the cases. Mishaps due to anesthetic machine malfunction include 6% of the cases and breathing circuit disconnection includes 7% of the cases. Aspiration pneumonia and medication errors occurred in equal number of the cases including 5% of the cases for each mishap. Awareness under anesthesia mishaps due to drug overdose, and unanticipated difficult airway also occurred in equal number of the cases including 2% of the cases for each mishaps. Corneal abrasion and accidental pneumothorax have the least incidence of anesthesia mishaps including 1% of the cases for each mishap. In this study, anesthesia mishaps due to human factor represent 87% of the cases and due to machine factor represent 13% of the cases. Human factors play an important role of morbidity and mortality, alteration and vigilance is required in even the most straightforward cases because unanticipated problems may happen at any moment. Fatigue, stress and lack of sleep may slow response to critical events, recent data suggest that a better safety record is provided when a trained nurse anesthetist and trained anesthesiologist supervise anesthesia care. Modern anesthesia must be more than administration of drugs, the anesthesiologist must anticipate and react to changes induced by surgery and be familiar with the changes that occur in the response to drugs in sick patients. Extensive training is required of anesthesia providers, nurse anesthetists, anesthesia assistants or anesthesiologists.Conclusion: Airway mishaps represent high incidence especially laryngospasm in 23% of the cases. Intraoperative pain was another mishaps and represents 13% of the cases especially in emergency hospital. Anesthetic machine and breathing circuit disconnection occurred in 13% of the cases. Other anesthesia mishaps which occurred nearly in the same incidence is extravasation, medication error and aspiration pneumonia. Anesthesia mishaps with lower incidence in Zagazig University Hospitals are awareness under anesthesia, drug overdose, corneal abrasion and accidental pneumothorax. In this study, human error plays a significant role in anesthesia mishaps and represents 87% of the cases while machine error represents 13% of the cases.