ASA (American Society of Anesthesia) Classification Scale

ASA (American Society of Anesthesia) Classification Scale

Class I	Normal healthy patient	Appropriate for moderate sedation
Class II	Patient with mild systemic disease (without substantive functional limitations) Current smoker Social alcohol drinker Pregnancy Obesity (BMI < 35) Well controlled DM or HTN Mild lung disease	Appropriate for moderate sedation
Class III	Patient with one or more severe to moderate systemic diseases (substantive functional limitations) Poorly controlled DM or HTN COPD Morbid obesity (BMI > 40) Active hepatitis Alcohol dependence or abuse Implanted pacemaker Moderate reduction of ejection fraction End stage renal disease with dialysis >3-month history of MI, CVA, TIA, or coronary artery disease with stents	Requires careful evaluation by a provider regarding the involvement of anesthesia to ensure patient safety
Class IV	Patient with severe systemic disease that is a constant threat to life <3 month history of MI, CVA, TIA or coronary artery disease with stents Ongoing cardiac ischemia or severe valve dysfunction Severe reduction of ejection fraction Sepsis DIC, ARDS, or end stage renal disease not undergoing regular dialysis	Requires anesthesia consult
Class V	Moribund patient not expected to survive without surgery Ruptured abdominal/thoracic aneurysm Massive trauma Intracranial bleed with mass effect Ischemic bowel in the face of significant cardiac pathology Multiple organ system dysfunction	Requires anesthesia consult
Class VI	Declared brain dead patient whose organs are being removed for donor purposes

Note: The addition of an “E” after any class 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.

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Table 8.21