The American Society of Anaesthesiology classification of physical status(ASA) is still used widely as a scoring system to assess the fitness of patients subjected to anaesthesia and surgery. The scoring system was devised to assess the physical status of patients before anaesthesia is planned and was applied uniformly for all patients.The grading system was useful for record keeping and for statistical analysis of patients' health status who were scheduled for administration of anaesthesia.This grading system is not indicated for prediction of operative risk.
ASA Classification
(ASA I) or (CLASS 1 ) or (Grade 1 ):
- Normal healthy patients.
- Patients can walk one flight of stairs or two level city blocks without distress. Little or no anxiety. Little or no risk.
- No clinical co-morbidity, no significant past or present medical or surgical history.
N.B: No organic, physiologic, or psychiatric disturbance; excludes the very young and very old; healthy with good exercise tolerance.
(ASA II) or (CLASS 2 ) or (Grade 2 ):
- Patients have mild to moderate systemic disease which is well controlled.
- Patients are able to walk up one flight of stairs or two level city blocks, but with moderate levels of exertional distress.
- Examples: History of well-controlled disease states including non-insulin dependent diabetes, pre-hypertension, epilepsy, asthma, or thyroid conditions, Patients with anginal symptoms less than once a week, High blood pressure treated with a single type of medicine, or asthma controlled by inhalers.or ASA I with a respiratory condition, pregnancy, and/or active allergies.
- May need medical consultation.
N.B: No functional limitations; has a well-controlled disease of one body system; controlled hypertension or diabetes without systemic effects, cigarette smoking without chronic obstructive pulmonary disease (COPD); mild obesity, pregnancy.
(ASA III) or (CLASS 3 ) or (Grade 3 ):
- Patients with severe systemic disease that limits activity, but is not incapacitating.
- Patients are able to walk up one flight of stairs or two level city blocks, but will have to stop enroute because of distress.
- Examples: Angina symptoms more than once a week(History of angina pectoris), Taking more than one blood pressure tablet ,Having complications of diabetes such as kidney failure or poor circulation, Asthma requiring frequent hospital admissions, Respiratory disease [COPD / COAD] causing breathlessness climbing a single flight of stairs, Someone with a raised creatinine of less than 200 micro mol/L without dehydration, myocardial infarction, or cerebrovascular accident, congestive heart failure over six months ago, slight chronic obstructive pulmonary disease, and controlled insulin dependent diabetes or hypertension.
- Will need medical consultation.
N.B: Some functional limitation; has a controlled disease of more than one body system or one major system; no immediate danger of death; controlled congestive heart failure (CHF), stable angina, old heart attack, poorly controlled hypertension, morbid obesity, chronic renal failure; bronchospastic disease with intermittent symptoms.
(ASA IV) or (CLASS 4 ) or (Grade 4 ):
- A Patient with severe systemic disease that is a constant threat to life.
- Patients are unable to walk up one flight of stairs or two level city blocks. Distress is present even at rest.
- Examples: Advanced liver disease, severe COPD, ARDS, History of unstable angina pectoris, myocardial infarction or cerebrovascular accident within the last six months, severe congestive heart failure, , and uncontrolled diabetes, hypertension, epilepsy,etc.
N.B: Has at least one severe disease that is poorly controlled or at end stage; possible risk of death; unstable angina, symptomatic COPD, symptomatic CHF, hepatorenal failure.
(ASA V) or (CLASS 5 ) or (Grade 5 ):
- Moribund patients who are not expected to survive without the operation( not expected to survive 24 hours with or without surgery ; imminent risk of death).
- These patients are almost always hospitalized, terminally ill patients.
- Examples: Severe gangrenous intestine in septic shock or terminally ill patients, multiorgan failure, sepsis syndrome with hemodynamic instability, hypothermia, poorly controlled coagulopathy.
(ASA VI) or (CLASS 6 ) or (Grade 6 ):
A declared brain-dead patient who organs are being removed for donor purposes (A brain dead donor for organ harvestation).
ASA-E:
Emergency operation of any variety.
(used to modify one of the above classifications, i.e., ASA III-E).
If the surgery is an emergency, the physical status classification is followed by “E” (for emergency) for example “3E”.
-Example: Class 5 is usually an emergency and is therefore usually "5E".
Note:
The class "6E" does not exist and is simply recorded as class "6", as all organ retrieval in brain-dead patients is done urgently .