ASA physical status I II III IV V VI
Definition Healthy Mild systemic disease Severe systemic disease but not incapacitating Incapacitating disease Dying Declared brain death
Age > 3 months to < 65 years ≤ 3 months or ≥ 65 to 84 years ≤ 1 month preterm NB or ≥ 85 years
Functional capacity; walk up 1 flight of stair or 200 m. on the level Complete without distress Rest at completion because of distress Stop en route because of distress Unable to do
Medical status 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 Poorly controlled systemic disease(s) Significant functional limitation Constant potential threat to life End stage disease(s) and not expected to survive within 24 hours Clinically dead patients awaiting organ harvest
Mortality rate (%) 0.06 – 0.08 0.27 – 0.4 1.8 – 4.3 7.8 – 23 9.4 – 51
Physiological status Normal healthy patient Healthy pregnant woman Active allergies Pre-existing disease in pregnancy, GDM, PIH, Mild pre-eclampsia Severe preeclampsia, Eclampsia, HELLP syndrome
CVS HT with BP < 140/90 mmHg BP > 180/110 mmHg Stable angina MI > 6 months / Cardiac arrhythmia without hemodynamic instability Compensated heart failure EF 25% - 50% 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
RS Well controlled asthma (attack < 1 per week) Heavy smoker (> 20 pack year) without COPD Stress-/ exercise- induced or hospitalized asthma COPD on medications Asthma or COPD with exacerbation
CNS Well controlled epilepsy Parkinsonism Dementia Alzeihmer’s disease GCS > 13 Stroke > 6 months with or without neurologic sequelae GCS 9 to 12 Uncontrolled epilepsy Stroke < 6 months or bed-ridden status GCS < 8
Endocrine Well controlled diabetes of any type Controlled hyper- or hypothyroidism with clinically euthyroidism Obesity class II (BMI 35 – 39.99) Poor controlled diabetes Symptomatic hypo/hyperthyroidism Obesity class III or morbid obesity (BMI 40 – 44.99) DKA / Hyperosmolar nonketotic acidosis Thyroid crisis Obesity class IV (BMI ≥ 45 )
GI Cirrhosis child A Significant liver enzyme abnormality Cirrhosis child B Cirrhosis child C Hepatic encephalopathy
Hematology Anemia (Hct < 30%) Thalassemia minor e.g. Thalassemia trait, Hb E, Hb CS, Hb H Platelet 50,000100,000 INR 1.2-1.5 Symptomatic anemia (Hct < 25%) Thalassemia major Platelet < 50,000 INR > 1.5 Platelet < 50,000 r INR > 1.5 with bleeding DIC
Renal Renal impairment CKD stage 1-2 Asymptomatic electrolyte imbalance CKD stage 3-5 ESRD Symptomatic electrolyte imbalance ESRD with volume overload or uremia Hepatorenal syndrome
Others SIRS Malnutrition (BMI < 16.5) Hypoalbuminemia (albumin < 2.5) Septicemia Septic shock MODS