ASA Classification

The ASA classification (American Society of Anesthesiologists) is carried out in

clinical practice since 1941.

It is a classification of the physical state, being used in the characterization of

patients who will undergo surgery and/or use anesthesia for risk assessment
surgical.

It is a metric used in all areas of health, having a

ASA classification for dentists and even for veterinarians.

The analysis regarding the following information is considered:

health conditions;
treatments;
patient behavior;
chronic diseases.
It is currently divided into six classifications, which increase as
risk ratio in surgery.

This classification is carried out before the procedure, whether in the case of surgery or
of anesthesia, part of the pre-anesthetic assessment conducted by a doctor
anesthesiologist.

Pre-anesthetic evaluation

This evaluation is a consultation carried out when the patient needs to receive something
type of anesthesia, whether local or general.

In this assessment, the healthcare professional asks the patient questions to

to inform about your physical and psychological conditions.

It is necessary to seek all clinical information about the patient, such as

example:

If the patient has pre-existing diseases;

Allergies;
Do you use any medication, and if so, what is it and what is your daily dose?
 If you have already undergone surgery where anesthesia was necessary, whether
local or general;
What surgery will the patient undergo and/or be subjected to.
Based on this information, the health professional will be able to do the
patient's ASA classification and also check what care he will need.
take before, during, and after the procedure.

Additionally, the type of anesthesia to be applied is analyzed:

Types of anesthesia

As mentioned earlier, there are two types of anesthesia.

Local anesthesia, which provides a temporary block of nerve endings.

of the patient, changing their sensations without altering consciousness.

And the general anesthesia, which sedates the person deeply, where the patient loses the
consciousness, sensitivity and also reflections of the body.

It is performed in surgeries so that the patient does not feel pain and discomfort during
the procedure, not being recommended unless it is necessary.

General anesthesia can be administered through:

From the vein: it has an immediate effect on the patient.

From a mask: the anesthesia is inhaled, reaching the bloodstream.

through the lungs.
The durations are always determined by the anesthetist, who will decide the type, dose and
also the amount of anesthetic medication applied.

Finally, through the evaluation, it is possible to measure the surgical risk of the patient.

Surgical risk

The surgical risk protocol is designed to reduce the risks of mortality from
patient, increasing the chances of surgery success.

This risk can be formed by classifications, such as the ASA classification and
also through physical examinations and/or supporting tests.

It is a calculation based on clinical assessment as well.

laboratory, recommending or not the surgery.
Every surgical operation carries risks, and because of this, each case must be
analyzed based on the factors mentioned above (pre-anesthetic evaluation) and others.

Some diseases have the potential to increase surgical trauma or impact on

patient recovery, such as:

chronic diseases;
family history;
nature of the surgery;
lack of nutrients.
Thus, the decision is made whether or not to perform the surgery, as if the risk is not ...
equal to or greater than the benefit that the surgery will bring, the recommendation is not to proceed
the procedure.

A common example is surgery in people over 70 years old, as

Depending on the case, it may be that the surgery does not bring as many benefits as the
risk, since the state of health may be weakened.

With health conditions like this, surgery is recommended in few cases, as

it overloads the body's systems, especially the apparatus
cardiovascular (heart and blood vessels)

In cases like that of the elderly, it is necessary for the cardiovascular system to be strong.
to avoid collapsing during the surgery.

When health is weakened, it is common for surgery to cause:

sequelae;
health complications;
delay for recovery;
death;
among others.
For this reason, various tests and classifications are carried out, which also
it was determined that the evaluation will be comprehensive (with exams and diagnostics by
image) or not.
What is the importance of the ASA classification?

ASA is one of the most widely accepted classifications by the scientific community.
She observes the patient's physiology concerning the anesthesia that will be used and the
surgery.

Its greater importance lies in the patient's well-being, as with the classification
It is almost always possible to ensure the success of the guarantee.

As mentioned earlier, this classification has six categories, check it out

they

ASA Classification I

This is about the group of people who are healthy, with none of these.
disturbances:

organic
physiological
biochemist
psychiatric.
That is, 100% healthy patients who do not smoke and do not use
large amounts of alcohol.

Cases such as a patient with hernias or fractures are accepted in this classification.

Patients with ASA classification I do not need imaging diagnoses or

laboratory exams, due to your excellent state of health.

Only the anamnesis and clinical assessment are sufficient to proceed with the
surgical procedure.

In this classification, the perioperative mortality rate is 0.06 to 0.08%.

ASA II classification

This classification includes patients with mild systemic diseases to

moderate, which are usually not related to surgery.

These diseases do not harm or affect the functionalities of the body and
in this classification it is possible to apply to patients:
 smokers;
pregnant women;
with diabetes;
with mild lung disease;
who consume alcoholic beverages socially;
with mild heart disease.
In this way, it is possible to diagnose based on diseases that do not affect the
functions of the organism and proceed to the next classification.

In this classification, the perioperative mortality is between 0.27 and 0.40%.

ASA III classification

Patients with more severe systemic disorders are classified as ASA III.
that may or may not be related to surgery.

Thesediseasescan harm or limit some functionalities of the

organism, such as:

implanted cardiac pacemaker;

patient with a history of heart attack;
poorly controlled diabetes
uncontrolled hypertension;
among others.
It is necessary to examine the patient's history to check if they do not fit.
in this classification.

In this classification, the perioperative mortality is 1.8 to 4.3%.

ASA Class IV

It is about patients with severe systemic disorders that compromise risk.

of constant life, with or without surgery.

Next, check out some examples of patients that fit this.

ASA classification:

patients with stroke (AVC);

cerebral ischemia;
 myocardial ischemia;
patients with recent heart attack;
acute respiratory failure;
chronic heart failure (CHF);
severe kidney disease;
among others.
In this classification, the perioperative mortality is between 7.8% and 23%.

ASA V Classification

It is the classification that indicates that the patient will have no hope of survival if
do not undergo surgery urgently.

In other words, surgery is your last resort.

In this classification, the perioperative mortality is between 9.4% and 51%.

ASA VI

This concerns patients with declared brain death, in which the organs will be
withdrawn for donation.

In this classification, the perioperative mortality is 100%.

After the classification, what is done

Along with the ASA classification, some pre-anesthesia precautions are taken for
guarantee the well-being of the patient, such as:

Pre-anesthesia care

Even before the surgical procedure, some precautions are taken to

may the anesthesia be received effectively.

A fasting period of 6 hours for solids and 8 hours when there is a

meal with a lot of food or if the food consumed is fatty.

For liquids, it is recommended to wait 6 hours for non-human milk or formula.

while for breast milk the period corresponds to 4 hours.
Clear liquids, without grains or water, require a fasting period of at least
minimum 2 hours.

In addition, it is necessary to remove removable dental pieces, such as:

dentures;
pivots;
bridges.
The counseling of the patient on the day of surgery regarding not to use
cosmetics such as makeup and also accessories, such as:

watches
bracelets
earrings
rings
among others.
Finally, always make it clear to the patient that it is necessary to avoid the consumption of
alcoholic beverages a few days before the surgery and also avoid smoking.

All of this must be carried out after the ASA classification to ensure well-being
of the patient before, during, and after the procedure.

Conclusion

Based on the ASA classification, it is possible to know which procedures should be taken.
to be taken, in the case of surgery.

Patients classified as ASA I and II are considered low risk, while

Patients with ASA III and IV are at high risk.

Right after, we have the ASA V, and those who were classified at this level already need
from surgery to survive, while the VI is an organ donor.

In this way, decisions are made regarding the procedure that will be performed, which
also influences surgical risk.

It is common for some procedures to have higher cardiac surgical risks,

regardless of the patient, such as:
Emergency, urgent, or vascular surgeries carry a high risk, with an index
greater than 5%.

Aneurysms of the abdominal aorta, endovascular correction or surgeries in the area of

head, neck, prostate, orthopedic and intrathoracic have a risk of 1 to
5%.

Meanwhile, endoscopies, cataract surgery, breast surgery or others

superficial procedures have a risk of less than 1%.

With these items analyzed, it is possible to perform the surgery or not, ensuring the
patient well-being above all.