Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab. DCA, Dip. Software statistics Ph D (physiology) Mahatma Gandhi medical college and research institute, puducherry, India

Case - what is the ASA status ??  Asymptomatic patient pregnant  Congenital complete heart block  For LSCS  What is the ASA status ??

ASA physical status  1.A normal healthy patient.  2.A patient with mild systemic disease.  3.A patient with moderate systemic disease.  4.A patient with severe systemic disease that is a constant threat to life.  5.A moribund patient who is not expected to survive without the operation.  6.A declared brain-dead patient whose organs are being removed for donor purposes

 If the surgery is an emergency, the physical status classification is followed by “E”  Healthy patient for emergency LSCS = I E  Mild hypertension for I & D = II E

 Class V and VI  Do they have E ??  The original definition of emergency in 1940, when ASA classification was first designed, was "a surgical procedure which, in the surgeon's opinion, should be performed without delay

Is it true ??  Fracture for reduction  Ureteric stone for lithoclast  Are they emergencies??  To write ASA status in routine or roman letters??

The purpose of the grading system  to assess the degree of a patient’s "sickness" or "physical state" prior to selecting the anesthetic or prior to performing surgery.  Describing patients’ preoperative physical status is used for recordkeeping,  for communicating between colleagues,  to create a uniform system for statistical analysis.

Perioperative mortality rate  ASA 1 = %  ASA 2 = %  ASA 3 = %  ASA 4 = %  ASA 5 = %

 A un ruptured ovarian cyst  For surgery  Pregnant or nonpregnant  Same ASA  Add “p”

Examples of ASA 2  History of well-controlled disease states including non-insulin dependent diabetes, prehypertension,  epilepsy,  asthma, or  thyroid conditions  extreme anxiety

Examples of ASA 3  systemic disease that limits activity, but is not incapacitating  History of angina pectoris, myocardial infarction, or cerebrovascular accident, congestive heart failure over six months ago  chronic obstructive pulmonary disease, and controlled insulin dependent diabetes or hypertension

ASA 4 – incapacitating  History of unstable angina pectoris,  myocardial infarction or cerebrovascular accident within the last six months,  severe congestive heart failure,  severe chronic obstructive pulmonary disease and type II Resp. failure

Limitations  Laparotomy  6month old  24 year old  75 year old  same ASA status ??

ASA status for hernioplasty ?  diabetes + hypertension  Anemia + diabetes  Hypothyroidism + bronchial asthma  Epilepsy + cirrhosis

Limitations  heart attack (myocardial infarction), though grave, is a 'local' disease  and is not a 'systemic' disease,  Bronchiectasis – systemic illness??  Does it truly fit in any category of the ASA classification ??

Limitations-Difficult airway  Post burns neck contracture  No systemic disease  ASA 1  No risk for anaesthesia ??

Looks like ASA 1 and everything is OK

She is ASA 1 only but

Limitations  Type of surgery ??  No systemic disease  ASA status !!  But  For haemorrhoidectomy or hemithyroidectomy ??

Limitations  64 year old male  For laparotomy & GJ  Malignant and nonmalignant  Same ASA status ??

10 hypothetical patients to 304 anaesthetists  Average 5.9  Regions  Academic anesthesiologists & private practice  for billing purposes and those who did not.  The ASA Physical Status Classification is useful but suffers from a lack of scientific precision

ASA status is fine  Good for risk classification but with some limitations