Evaluating the Patient Before Anesthesia - Anesthetic Assessment and Plan

ASA physical status class

ASA physical status class. ASA class provides an overall impression of the severity of the patient’s illness. The six physical classes are described in Table 1.1.

Airway management

Airway management. Plan for a natural airway or placement of either a laryngeal mask airway (LMA) or endotracheal tube should take into consideration the patient’s current airway examination, past airway management, aspiration risk, and the planned procedure, including positioning and estimated duration.

Monitoring

Monitoring. The healthy patient undergoing minimally invasive surgery needs only the standard ASA monitors. However, if the patient has significant cardiovascular disease, pulmonary disease, or is at risk for blood loss, invasive monitoring such as a central line and arterial line should be considered for the granularity of hemodynamic status and assessing blood gases and cell counts frequently.

Anesthetic options

Anesthetic options. Numerous methods are available for providing anesthesia, analgesia, and hemodynamic stability for any given type of surgery. General anesthesia, regional anesthesia, and combinations thereof should be reviewed and considered.

Tables

ASA Physical Status Classification System (Table 1.1)

ASA PS Classification Definition Adult Examples, Including, But Not Limited to
ASA I A normal healthy patient Healthy, nonsmoking, no or minimal alcohol use
ASA II A patient with mild systemic disease Mild diseases only without substantive functional limitations. Examples include (but not limited to): current smoker, social alcohol drinker, pregnancy, obesity (30 < BMI < 40), well-controlled DM/HTN, mild lung disease
ASA III A patient with severe systemic disease Substantive functional limitations; one or more moderate to severe diseases. Examples include (but not limited to): poorly controlled DM or HTN, COPD, morbid obesity (BMI ≥ 40), active hepatitis, alcohol dependence or abuse, implanted pacemaker, moderate reduction of ejection fraction, ESRD undergoing regularly scheduled dialysis, premature infant PCA < 60 wk, history (>3 mo) of MI, CVA, TIA, or CAD/stents.
ASA IV A patient with severe systemic disease that is a constant threat to life Examples include (but not limited to): recent (<3 mo) MI, CVA, TIA, or CAD/stents, ongoing cardiac ischemia or severe valve dysfunction, severe reduction of ejection fraction, sepsis, DIC, ARD or ESRD not undergoing regularly scheduled dialysis
ASA V A moribund patient who is not expected to survive without the operation Examples include (but not limited to): ruptured abdominal/thoracic aneurysm, massive trauma, intracranial bleed with mass effect, ischemic bowel in the face of significant cardiac pathology or multiple organ/system dysfunction
ASA VI A declared brain-dead patient whose organs are being removed for donor purposes

Outline