ASA grading.
| ASA classification | Patient characteristics | Examples |
|---|---|---|
| ASA I | A normal healthy patient | Healthy; no smoking, no or very minimal drinking |
| ASA II | A patient with mild systemic disease | Smoker; more than minimal drinking; pregnancy; obesity; well controlled diabetes; well controlled hypertension; mild lung disease |
| ASA III | A patient with severe systemic disease. Not incapacitating | Diabetes; poorly controlled hypertension; distant history of MI, CVA, TIA, cardiac stent; COPD, ESRD with dialysis; active hepatitis; implanted pacemaker; ejection fraction <40%; congenital metabolicabnormalities |
| ASA IV | A patient with severe systemic disease that is a constant threat to life | Recent history of MI, CVA, TIA, cardiac stent; on-going cardiac ischaemia or valvular abnormality; implanted ICD, ejection fraction <28% |
| ASA V | A moribund patient who is not expected to survive without the operation | Ruptured abdominal or thoracic aortic aneurysm; intra-cranial bleed with mass effect; ischaemic bowel with significant cardiac pathology. |
| ASA VI | A patient who has already been declared brain dead and whose organs are being retrieved for transplant |
The addition of ‘E’ indicates emergency surgery. ASA = American Society of Anesthesiologists; COPD = chronic obstructive pulmonary disorder; CVA = cerebrovascular accident; ESRD = end-stage renal disease; ICD = implantable cardioverter defibrillator; MI = myocardial infarction; TIA = transient ischaemic attack.