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ASA Classification

Created
Last Update
Ross Hanrahan

ASA Examples1

MBS Examples2


I
A normal healthy patient

Healthy, non-smoking, no or minimal alcohol use

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II
A patient with mild systemic disease

Mild diseases only without substantial functional limitations

  • Current smoker
  • Social alcohol drinker
  • Pregnancy
  • Obesity (30 < BMI < 40)
  • Well controlled DM / HT
  • Mild lung disease
  • Hypertension with no effect on lifestyle
  • Angina on substantial exertion but not limiting normal activity
  • Well controlled insulin dependent diabetes

III
A patient with severe systemic disease

Substantive functional limitations. One or more moderate to severe diseases

  • Poorly controlled DM or HT
  • COPD
  • Morbid obesity (BMI ≥ 40)
  • Active hepatitis
  • Alcohol dependence or abuse
  • Implanted pacemaker
  • Moderate reduction of ejection fraction (LVEF 36-44%)
  • History (> 3 months) of MI, CVA, TIA or CAD/ stents
  • Frequent angina on exertion signifiantly limiting activities
  • Airways disease sufficent to prevent climbing a single flight of stairs without pausing
  • CVA with residual deficit significantly limiting normal activity (eg hemiparesis)
  • Renal failure requiring regular dialysis

IV
A patient with severe systemic disease that is a constant threat to life
  • Recent (<3 months) MI, CVA. TIA or CAD/ stents
  • Ongoing cardiac ischaemia
  • Severe valve disease
  • Severe reduction of ejection fraction (≤ 35%)
  • Shock
  • Sepsis
  • DIC
  • ARDS
  • ESRF not undergoing regular scheduled dialysis
  • Angina on minimal exertion severely curtailing normal activity
  • End stage emphyseme causing breathlessness on brushing hair or walking less than 20 metres
  • Severe diabetes causing
    • Severe visual impairment
    • PVD causing intermittent claudication walking less than 20 metres
    • IHD causing cardiac failure or angina with minimal activity

V
A moribund patient who is not expected to survive 24 hours with or without the operation
  • Ruptured abdominal/ thoracic aneurysm
  • Massive trauma
  • Intracranial bleed with mass effect
  • Ischaemic bowel in the face of significant cardiac pathology
  • Multiple organ dysfunction
  • A burst abdominal aneurysm with profound shock
  • Major cerebral trauma with increasing intracranial pressure
  • Massive pulmonary embolus

ASA Classifications Examples 3

I
A normal healthy patient

Healthy, non-smoking, no or minimal alcohol use

II
A patient with mild systemic disease

Mild diseases only without substantial functional limitations

  • Current smoker
  • Social alcohol drinker
  • Pregnancy
  • Obesity (30 < BMI < 40)
  • Well controlled DM / HT
  • Mild lung disease

III
A patient with severe systemic disease

Substantive functional limitations. One or more moderate to severe diseases

  • Poorly contolled DM or HT
  • COPD
  • Morbid obesity (BMI ≥ 40)
  • Active hepatitis
  • Alcohol dependence or abuse
  • Implanted pacemaker
  • Moderate reduction of ejection fraction (LVEF 36-44%)
  • History (> 3 months) of MI, CVA, TIA or CAD/ stents

IV
A patient with severe systemic disease that is a constant threat to life
  • Recent (<3 months) MI, CVA. TIA or CAD/ stents
  • Ongoing cardiac ischaemia
  • Severe valve disease
  • Severe reduction of ejection fraction (≤ 35%)
  • Shock
  • Sepsis
  • DIC
  • ARDS
  • ESRF not undergoing regular scheduled dialysis

V
A moribund patient who is not expected to survive 24 hours with or without the operation
  • Ruptured abdominal/ thoracic aneurysm
  • Massive trauma
  • Intracranial bleed with mass effect
  • Ischaemic bowel in the face of significant cardiac pathology
  • Multiple organ dysfunction

References

  1. ASA physical status classification system
  2. MBS ASA Physical Status Description
  3. ref:1
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