ASA physical status class. ASA class provides an overall impression of the severity of the patient’s illness. The six physical classes are described in Table 1.1.
| ASA PS Classification | Definition | Adult Examples, Including, But Not Limited to |
|---|---|---|
| ASA I | A normal healthy patient | Healthy, nonsmoking, no or minimal alcohol use |
| ASA II | A patient with mild systemic disease | Mild diseases only without substantive functional limitations. Current smoker, social alcohol drinker, pregnancy, obesity (30 < BMI < 40), well-controlled DM/HTN, mild lung disease |
| ASA III | A patient with severe systemic disease | Substantive functional limitations; one or more moderate to severe diseases. Poorly controlled DM or HTN, COPD, morbid obesity (BMI ≥ 40), active hepatitis, alcohol dependence or abuse, implanted pacemaker, moderate reduction of ejection fraction, ESRD undergoing regularly scheduled dialysis, history (>3 mo) of MI, CVA, TIA, or CAD/stents |
| ASA IV | A patient with severe systemic disease that is a constant threat to life | Recent (<3 mo) MI, CVA, TIA, or CAD/stents, ongoing cardiac ischemia or severe valve dysfunction, severe reduction of ejection fraction, shock, sepsis, DIC, ARD, or ESRD not undergoing regularly scheduled dialysis |
| ASA V | A moribund patient who is not expected to survive without the operation | Ruptured abdominal/thoracic aneurysm, massive trauma, intracranial bleed with mass effect, ischemic bowel in the face of significant cardiac pathology or multiple organ/system dysfunction |
| ASA VI | A declared brain-dead patient whose organs are being removed for donor purposes |
ARD, acute respiratory distress; ASA, American Society of Anesthesiologists; BMI, body mass index; CAD, coronary artery disease; COPD, chronic obstructive pulmonary disease; CVA, cerebrovascular accident; DIC, disseminated intravascular coagulation; DM, diabetes mellitus; ESRD, end-stage renal disease; HTN, hypertension; MI, myocardial infarction; TIA, transient ischemic attack.
The addition of “E” denotes Emergency surgery: (An emergency is defined as existing when delay in treatment of the patient would lead to a significant increase in the threat to life or body part).
Excerpted from ASA Physical Status Classification System, 2020 of the American Society of Anesthesiologists. A copy of the full text can be obtained from ASA, 1061 American Lane Schaumburg, IL 60173–4973 or online at www.asahq.org
Airway management. Plan for a natural airway or placement of either a laryngeal mask airway (LMA) or endotracheal tube should take into consideration the patient’s current airway examination, past airway management, aspiration risk, and the planned procedure, including positioning and estimated duration.
Monitoring. The healthy patient undergoing minimally invasive surgery needs only the standard ASA monitors. However, if the patient has significant cardiovascular disease, pulmonary disease, or is at risk for blood loss, invasive monitoring such as a central line and arterial line should be considered for the granularity of hemodynamic status and assessing blood gases and cell counts frequently.
Anesthetic options. Numerous methods are available for providing anesthesia, analgesia, and hemodynamic stability for any given type of surgery. General anesthesia, regional anesthesia, and combinations thereof should be reviewed and considered.