ASA Physical Status and Sedation
Robert Bullock MD
In an effort to clarify ASA Physical status required on all patients for whom procedural sedation is planned, the following review is provided:
1) ASA 1: A normal healthy patient.
2) ASA 2: A patient with mild systemic disease, e.g. controlled hypertension, mild diabetes.
3) ASA 3: A patient with severe systemic disease, e. g. coronary artery disease, insulin dependent diabetes mellitus, COPD, renal insufficiency.
4) ASA 4: A patient with severe systemic disease that is a constant threat to life, e. g. unstable angina, congestive heart failure, sepsis, renal failure
If an ASA 4 classification is properly applied it serves notice to the practitioner that more careful sedation, titrated in lower doses, is indicated. Advanced age is also an important added factor to be considered. Further examples of an ASA 4 classification would be any patient for heart catheterization when a stent might be used (unstable angina?), any patient who needs a pacemaker or AICD, any patient in IR for coiling for aneurysm, bleeding varices, and so on. ASA 4 = Caution!
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