Pre-operative Management
ASA PHYSICAL STATUS
The American Society of Anaesthesiologists (ASA) classification does not embrace all aspects of anaesthetic risk, but is internationally applied for all surgical patients.
ASA PHYSICAL STATUS SCALE
ASA 1 : A normal healthy individual
(No organic, biochemical or psychiatric disease Surgical problem localized)
ASA 2 : Mild systemic disease with no limitation of activity
(mild asthma, diabetes, hypertension, obesity, anaemia) ASA 3 : Moderate disease with functional limitation (myocardial infarction with complications, angina, COPD)
ASA 4 : Severe systemic disease - a constant threat to life (unstable angina, cardiac, hepatic or renal failure)
ASA 5 : Moribund patient
(expecting high mortality <24hrs with or without surgery) ASA 6 : Brain dead donor
(awaiting organ retrieval)
E: Emergency surgery (haemorrhage, head injury)
Pre-operative Optimization
Anaesthesia for routine surgery is contraindicated in the following: Chronic uncontrolled medical diseases
(cardiac failure, hypertension, diabetes, asthma, COPD, hepatic and renal disease) Acute illness (myocardial infarct within 3 months, wheezing, severe respiratory infection, viral hepatitis, influenza, ete.)
Inadequate fasting period (<6h for solids)
High risk patients must be identified before surgery, and medically optimised to reduce
morbidity and mortality.
This requires assessment preferably some days or even weeks before planned surgery, and as soon as possible before emergency surgery.
Treat identified problems and optimise all disease medication,
Commence chest physiotherapy, dental treatment ete where appropriate.
Check need for and availability of blood.
Check need for and availability of ICU bed.