ASSESSMENT OF PATIENTS FITNESS FOR ENDOSCOPY:

American Society of Anesthesiologists (ASA) grade is the most commonly used grading system to assess fitness for surgery or Endoscopy. Use the following information and table to help you assess the risk v. benefit for your patient:

·  Medical co-morbidity increases the risk associated with anaesthesia and surgery

·  ASA accurately predicts morbidity and mortality

·  50% of patients presenting for elective surgery are ASA grade 1

·  ‘Operative mortality’ for these patients is less than 1 in 10,000

·  Risks for endoscopic procedures increase with their complexity.

ASA / Assessment of Fitness / % mortality
predicted
Class I / Healthy Patient / 0.05
Class II / Mild Systemic Disease, No Functional Limitations, No acute problems (e.g. controlled hypertension, mild diabete, chronic bronchitis, asthma) / 0.4
Class III / Severe Systemic Disease, Definite functional limitation (e.g. brittle dabetic, frequent angina, mycardial infarction) / 4.5
Class IV / Severe systemic disease with acute, unstable symptoms (e.g. recent [3 months] mycardial infarction, congestive heart failure, acute renal failure, ketoacidosis, uncontrolled active asthma) / 25
Class V / Severe systemic disease with imminent risk of death, moribund / 50

Clinical Application of ASA Grading

Cardiovascular disease: ASA Grade 2 ASA Grade 3

Angina Occasional use of GTN. Regular use of GTN

or unstable angina

Hypertension Well controlled on single agent Poorly controlled. Multiple drugs

Diabetes Well controlled. Poorly controlled or complications

No complications

Respiratory disease ASA Grade 2 ASA Grade 3

COPD Cough or wheeze. Breathless on minimal exertion

Well controlled

Asthma Well controlled with inhalers Poorly controlled.

Limiting lifestyle

Bibliography

Arenal J J, Bengoechea-Beeby M. Mortality associated with emergency abdominal surgery in the elderly. Can J Surg 2003; 46: 111-116.

El-Haddawi F, Abu-Zidan F M. Jones W. Factors affecting the surgical outcome in the elderly at Auckland Hospital. Aust NZ J Surg 2002; 57: 798-805