ASA P HYSICAL STATUS CLASSIFICATION

ASA physical status Definition I Healthy II Mild systemic disease 3 months or 65 to 84 years Rest at completion because of distress III Severe systemic disease but not incapacitating 1 month preterm NB or 85 years Stop en route because of distress Unable to do IV Incapacitating disease Dying V VI Declared brain death

Age Functional capacity; walk up 1 flight of stair or 200 m. on the level Medical status

> 3 months to < 65 years Complete without distress

No organic, physiologic, or psychiatric disturbance

Single/multiple systemic disease(s) with good control No functional limitations or vital organ involvement

Poorly controlled systemic disease(s) Some functional limitations No immediate life threatening condition 1.8 4.3

Poorly controlled systemic disease(s) Significant functional limitation Constant potential threat to life 7.8 23

End stage disease(s) and not expected to survive within 24 hours

Clinically dead patients awaiting organ harvest

Mortality rate (%) Emergency status

0.06 0.08

0.27 0.4

9.4 51

In addition to indicating ASA physical status, any patient undergoing an emergency operation is indicated by the suffix E, e.g., ASA III E

Examples of ASA physical status classification

ASA physical status Physiological status I Normal healthy patient II Healthy pregnant woman Active allergies HT with BP < 140/90 mmHg III Pre-existing disease in pregnancy, GDM, PIH, Mild pre-eclampsia BP > 180/110 mmHg Stable angina MI > 6 months / Cardiac arrhythmia without hemodynamic instability Compensated heart failure EF 25% - 50% Stress-/ exerciseinduced or hospitalized asthma COPD on medications Stroke > 6 months with or without neurologic sequelae GCS 9 to 12 IV Severe preeclampsia, Eclampsia, HELLP syndrome Unstable angina Acute MI MI <6 months Uncontrolled cardiac arrhythmias with hemodynamic instability Severe heart failure EF < 25% Ruptured aortic aneurysm Sepsis syndrome with hemodynamic instability S/P CPR V VI

CVS

RS

Well controlled asthma (attack < 1 per week) Heavy smoker (> 20 pack year) without COPD Well controlled epilepsy Parkinsonism Dementia Alzeihmers disease GCS > 13

Asthma or COPD with exacerbation

CNS

Uncontrolled epilepsy Stroke < 6 months or bed-ridden status GCS < 8

Examples of ASA physical status classification

ASA physical status Endocrine I II Well controlled diabetes of any type Controlled hyper- or hypothyroidism with clinically euthyroidism Obesity class II (BMI 35 39.99) Cirrhosis child A Significant liver enzyme abnormality Anemia (Hct < 30%) Thalassemia minor e.g. Thalassemia trait, Hb E, Hb CS, Hb H Platelet 50,000100,000 INR 1.2-1.5 Renal impairment CKD stage 1-2 Asymptomatic electrolyte imbalance SIRS Malnutrition (BMI < 16.5) Hypoalbuminemia (albumin < 2.5) III Poor controlled diabetes Symptomatic hypo/hyperthyroidism Obesity class III or morbid obesity (BMI 40 44.99) Cirrhosis child B IV DKA / Hyperosmolar nonketotic acidosis Thyroid crisis V VI

Obesity class IV (BMI 45 ) Cirrhosis child C Hepatic encephalopathy DIC

GI

Hematology

Symptomatic anemia (Hct < 25%) Thalassemia major Platelet < 50,000 INR > 1.5

Platelet < 50,000 r INR > 1.5 with bleeding

Renal

CKD stage 3-5 ESRD Symptomatic electrolyte imbalance Septicemia

ESRD with volume overload or uremia Hepatorenal syndrome Septic shock MODS

Others