ASA PS Definition Adult Examples, Pediatric Examples, Obstetric Examples, Examples of ASAPS
Classification Including, but not Including but not Including but not Limited to: Classification:
Limited to: Limited to:
ASA I A normal Healthy, non- Healthy (no acute or Patient 1 A 20-
healthy patient smoking, no or chronic disease), normal year-old college
minimal alcohol use BMI percentile for age athlete from
Brigham Young
University is
scheduled to
undergo an
elective ACL repair.
Nonsmoker,
nondrinker, no
medications, BMI
23. This patient
would be assigned
ASAPS Class 1.
ASA II A patient with Mild diseases only Asymptomatic Normal pregnancy*, well Patient 2 A 19-
mild systemic without substantive congenital cardiac controlled gestational HTN, year-old college
disease functional disease, well controlled controlled preeclampsia student from the
limitations. Current dysrhythmias, asthma without severe features, University of
smoker, social without exacerbation, diet-controlled gestational California - Santa
alcohol drinker, well controlled epilepsy, DM. Barbara (a top
pregnancy, obesity noninsulin dependent “party school”) is
(30<BMI diabetes mellitus, scheduled to
abnormal BMI undergo
percentile for age, emergency
mild/moderate OSA, orthopedic surgery
oncologic state in following a fall
remission, autism with from his frat house
mild limitations roof after
attending a weekly
“kegger”
party. The patient
takes recreational
medications only
(mostly cannabis)
and has a BMI of
29. This patient
would be assigned
ASAPS Class 2E by
being a frequent
social drinker and
being scheduled as
an emergency case.
Note that the “full
stomach” status of
the patient does
not figure into his
ASAPS yet still adds
considerably to his
overall anesthetic
risk.
ASA III A patient with Substantive Uncorrected Preeclampsia with severe Patient 3A 30-year-
severe systemic functional stable features, gestational DM old woman is
disease limitations; One or congenital with complications or high scheduled to
more moderate to cardiac insulin requirements, a undergo elective
severe diseases. abnormality, thrombophilic disease surgery for removal
Poorly controlled asthma with requiring anticoagulation. of a large ovarian
DM or HTN, COPD, exacerbation, cyst. Comorbidities
morbid obesity (BMI poorly controlled include anemia
≥40), active epilepsy, insulin from menorrhagia
hepatitis, alcohol dependent and type II diabetes
dependence or diabetes treated with
abuse, implanted mellitus, morbid metformin. She is a
pacemaker, obesity, non-smoker,
moderate reduction malnutrition, occasional social
of ejection fraction, severe OSA, drinker, and has a
ESRD undergoing oncologic state, BMI of 42. This
regularly scheduled renal failure, patient would be
dialysis, history (>3 muscular assigned ASAPS
months) of MI, CVA, dystrophy, Class 3.
TIA, or CAD/stents. cystic fibrosis,
history of organ
transplantation,
brain/spinal cord
malformation,
symptomatic
hydrocephalus,
premature infant
PCA <60
weeks, autism
with severe
limitations,
metabolic
disease, difficult
airway, long
term parenteral
nutrition. Full
term infants <6
weeks of age.
ASA IV A patient with Recent (<3 Symptomatic congenital Preeclampsia with severe Patient 4A 70-year-
severe systemic months) MI, CVA, cardiac abnormality, features complicated by old woman is
disease that is a TIA or CAD/stents, congestive heart failure, HELLP or other adverse scheduled to
constant threat ongoing cardiac active sequelae of event, peripartum undergo an
to life ischemia or severe prematurity, acute cardiomyopathy with EF <40, emergency
valve dysfunction, hypoxicischemic uncorrected/decompensated laparoscopic
severe reduction of encephalopathy, shock, heart disease, acquired or appendectomy.
ejection fraction, sepsis, disseminated congenital. Comorbidities
shock, sepsis, DIC, intravascular include severe
ARD or ESRD not coagulation, automatic COPD as a
implantable consequence of a
undergoing regularly cardioverterdefibrillator, life-long smoking
scheduled dialysis ventilator dependence, habit, morbid
endocrinopathy, severe obesity (BMI 46)
trauma, severe and type II
respiratory distress, diabetes. She gets
advanced oncologic short of breath
state. walking more than
a few meters. This
patient would be
assigned ASAPS
Class 4E.
ASA V A moribund Ruptured Massive trauma, Uterine rupture. Patient 5A 55-year-
patient who is abdominal/thoracic intracranial hemorrhage old man is
not expected to aneurysm, massive with mass effect, scheduled for
survive without trauma, intracranial patient requiring ECMO, emergency repair
the operation bleed with mass respiratory failure or of a ruptured
effect, ischemic arrest, malignant abdominal aortic
bowel in the face of hypertension, aneurysm. He is
significant cardiac decompensated brought to the
pathology or congestive heart failure, operating room
multiple hepatic encephalopathy, with CPR in
organ/system ischemic bowel or progress due to
dysfunction multiple organ/system asystole. He had
dysfunction. been intubated
earlier in the
Emergency
Department
without the need
for any drugs. This
patient would be
assigned ASAPS
Class 5E as he
would not be
expected to survive
beyond the next 24
hours with or
without surgery.
ASA VI A declared brain Patient 6A 25-year-
dead patient old man sustained
whose organs a severe head
are being injury in a
removed for motorcycle
donor purposes accident. He was
not wearing a
helmet. After a
neurosurgical
decompression
procedure and
numerous other
interventions in the
intensive care unit,
it is clear that there
is no hope for
recovery. He is
unresponsive to all
noxious
stimulation. Testing
for brain death is
carried out
according to the
American Academy
of Neurology
guidelines for Brain
Death
Determination
reveals a complete
absence of central
nervous system
function, and his
family agrees to
make his organs
available for
transplantation.
This patient would
be assigned ASAPS
Class 6.
The addition of “E” to the ASAPS (e.g., ASA 2E) denotes an emergency surgical procedure. The ASA defines an emergency as
existing “when the delay in treatment of the patient would lead to a significant increase in the threat to life or body part.”
References:
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