ASA STATUS
Dr. S. Parthasarathy
MD., DA., DNB, MD (Acu), Dip. Diab. DCA,
Dip. Software statistics
Ph D (physiology)
Mahatma Gandhi medical college and
research institute, puducherry, India
Case - what is the ASA status ??
 Asymptomatic patient pregnant
 Congenital complete heart block
 For LSCS
 What is the ASA status ??
ASA physical status
 1.A normal healthy patient.
 2.A patient with mild systemic disease.
 3.A patient with moderate systemic disease.
 4.A patient with severe systemic disease that is
a constant threat to life.
 5.A moribund patient who is not expected to
survive without the operation.
 6.A declared brain-dead patient whose organs
are being removed for donor purposes
 If the surgery is an emergency, the physical
status classification is followed by “E”
 Healthy patient for emergency LSCS = I E
 Mild hypertension for I & D = II E
 Class V and VI
 Do they have E ??
 The original definition of emergency in 1940,
when ASA classification was first designed,
was "a surgical procedure which, in the
surgeon's opinion, should be performed
without delay
Is it true ??
 Fracture for reduction
 Ureteric stone for lithoclast
 Are they emergencies??
 To write ASA status in routine or roman
letters??
The purpose of the grading
system
 to assess the degree of a patient’s "sickness"
or "physical state" prior to selecting the
anesthetic or prior to performing surgery.
 Describing patients’ preoperative physical
status is used for recordkeeping,
 for communicating between colleagues,
 to create a uniform system for statistical
analysis.
Perioperative mortality rate
 ASA 1 = 0.06-0.08%
 ASA 2 = 0.27-0.4%
 ASA 3 = 1.8-4.3%
 ASA 4 = 7.8-23%
 ASA 5 = 9.4-51%
 A un ruptured ovarian cyst
 For surgery
 Pregnant or nonpregnant
 Same ASA
 Add “p”
Examples of ASA
2
 History of well-controlled disease states




including non-insulin dependent diabetes,
prehypertension,
epilepsy,
asthma, or
thyroid conditions
extreme anxiety
Examples of ASA 3
 systemic disease that limits activity, but is
not incapacitating
 History of angina pectoris, myocardial
infarction, or cerebrovascular accident,
congestive heart failure over six months
ago
 chronic obstructive pulmonary disease, and
controlled insulin dependent diabetes or
hypertension
ASA 4 – incapacitating
 History of unstable angina pectoris,
 myocardial infarction or cerebrovascular
accident within the last six months,
 severe congestive heart failure,
 severe chronic obstructive pulmonary disease
and type II Resp. failure
Limitations
 Laparotomy
 6month old
 24 year old
 75 year old
 same ASA status ??
ASA status for hernioplasty ?
 diabetes + hypertension
 Anemia + diabetes
 Hypothyroidism + bronchial asthma
 Epilepsy + cirrhosis
Limitations
 heart attack (myocardial infarction), though
grave, is a 'local' disease
 and is not a 'systemic' disease,
 Bronchiectasis – systemic illness??
 Does it truly fit in any category of the ASA
classification ??
Limitations-Difficult airway
 Post burns neck contracture
 No systemic disease
 ASA 1
 No risk for anaesthesia ??
Looks like ASA 1 and
everything is OK
She is ASA 1 only but
Limitations
 Type of surgery ??
 No systemic disease
 ASA status !!
 But
 For haemorrhoidectomy or
hemithyroidectomy ??
Limitations
 64 year old male
 For laparotomy & GJ
 Malignant and nonmalignant
 Same ASA status ??
10 hypothetical patients
304 anaesthetists
to
 Average 5.9
 Regions
 Academic anesthesiologists & private
practice
 for billing purposes and those who did not.
 The ASA Physical Status Classification is
useful but suffers from a lack of scientific
precision
ASA status is fine
 Good for risk classification but with some
limitations