![[Pasted image 20260630163835.png]] - ASA I - A normal healthy patient, as follows: - Healthy - Nonsmoker - No or minimal alcohol consumption - ASA II - A patient with mild systemic disease without significant functional limitation or end-organ involvement, including but not limited to the following: - Active smoking - Social alcohol consumption - Pregnancy - [Obesity](https://emedicine.medscape.com/article/123702-overview) - BMI >30 but < 40 - Controlled [diabetes mellitus](https://emedicine.medscape.com/article/117853-overview) (DM) or [hypertension](https://emedicine.medscape.com/article/241381-overview) (HTN) - Mild lung disease - New York Heart Association (NYHA) class 1 congestive heart failure (CHF) - [Mild cognitive dysfunction](https://emedicine.medscape.com/article/1136393-overview) - Isolated mild-to-moderate [obstructive sleep apnea](https://emedicine.medscape.com/article/295807-overview) (OSA) with continuous positive airway pressure (CPAP) compliance - ASA III - A patient with one or more severe systemic diseases causing substantive functional limitation, including but not limited to the following: - [Chronic obstructive pulmonary disease (COPD)](https://emedicine.medscape.com/article/297664-overview) - Morbid obesity - BMI ≥40 - Active [hepatitis](https://emedicine.medscape.com/article/775507-overview) - Compensated [cirrhosis](https://emedicine.medscape.com/article/185856-overview) - [Alcohol dependence or abuse](https://emedicine.medscape.com/article/285913-overview) - Functional implanted pacemaker - Moderate reduction of ejection fraction (EF) or NYHA class 2 or 3 CHF - [End-stage renal disease](https://emedicine.medscape.com/article/2500089-overview) (ESRD), undergoing regular scheduled dialysis - History (>3 mo) of [myocardial infarction](https://emedicine.medscape.com/article/155919-overview) (MI), [cerebrovascular accident](https://emedicine.medscape.com/article/1916852-overview) (CVA), [transient ischemic attack](https://emedicine.medscape.com/article/1910519-overview) (TIA), [pulmonary embolism](https://emedicine.medscape.com/article/300901-overview) (PE), or [coronary artery disease](https://emedicine.medscape.com/article/153647-overview) (CAD)/stents - Significant cognitive dysfunction - Isolated severe OSA [2] regardless of CPAP compliance, or any severity of OSA with CPAP noncompliance - Poorly controlled DM or HTN with or without end-organ dysfunction. - ASA IV - A patient with severe systemic disease that poses a constant threat to life, including but not limited to the following: - Recent (< 3 mo) MI, CVA, TIA, or CAD/stents - Ongoing cardiac ischemia or severe valve dysfunction - Severe reduction of EF or NYHA class 4 CHF - Shock - [Sepsis](https://emedicine.medscape.com/article/234587-overview) - [Disseminated intravascular coagulation (DIC)](https://emedicine.medscape.com/article/199627-overview) - [Acute respiratory distress syndrome](https://emedicine.medscape.com/article/165139-overview) (ARDS) - ESRD, not undergoing regular scheduled dialysis - Uncompensated cirrhosis - Severe cognitive dysfunction - ASA V - A moribund patient not expected to survive without the operation, including but not limited to those with the following: - Ruptured [thoracic](https://emedicine.medscape.com/article/761627-overview) or [abdominal aneurysm](https://emedicine.medscape.com/article/1979501-overview) - Massive trauma - Intracranial bleeding with mass effect - Ischemic bowel with significant cardiac pathology - Multiple organ or system dysfunction - ASA VI - A declared brain-dead patient whose organs are to be removed for donation. The addition of “E” after the classification signifies emergency surgery; an emergency is considered to be present in cases where delaying treatment of the patient would result in a significantly increased threat to life or a body part. Apart from the common examples provided by ASA for the six classes, other conditions not specifically mentioned can be assigned an ASA class on the basis of the general principles underlying each classification.  The subjective nature of the ASA classification makes it challenging for clinicians to assign the correct class, and this has led to some criticism of the system for inconsistent status assignments. Updates to the ASA classification and the addition of examples have reduced these inconsistencies. [3] For better prediction of perioperative risk, other essential factors besides ASA class should be considered, including but not limited to the following [1] : - Age - Other comorbidities - Home medications - Duration and extent of the operative procedure - Anesthetic choice and medications administered - Surgical team skills and technique - Blood products required - Implants needed - Expected postoperative care The classification system can be used preoperatively to identify patients who are at high operative risk. Depending on the type of procedure, there is a variable trend toward increasing likelihood of complications and mortality with increasing ASA class. [