American society of Anaesthesiologists physical status (ASA PS) classification(last amended on december 2020)

ASA PS classification Definition Adult examples,including but not limited to Pediatric examples including but not limited to Obstetric examples including but not limited to I Normal healthy patient Healthy, nonsmoking, no or minimal alcohol use Healthy (no acute or chronic disease),normal BMI
percentile for
age II A patient with mild systemic disease Mild diseases only
without
substantive
functional
limitations. Current
smoker, social
alcohol drinker,
pregnancy, obesity
(30<BMI<40),
well-controlled
DM/HTN, mild
lung disease Asymptomatic
congenital
cardiac disease,
well controlled
dysrhythmias,
asthma without
exacerbation,
well controlled
epilepsy, noninsulin
dependent
diabetes
mellitus,
abnormal BMI
percentile for
age,mild/moderate
OSA, oncologic
state in
remission,
autism with mild
limitations Normal pregnancy*, well
controlled gestational HTN,
controlled preeclampsia
without severe features,
diet-controlled gestational
DM. III A patient with severe systemic disease Substantive
functional
limitations; One or
more moderate to
severe diseases.
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,
history (>3
months) of MI,
CVA, TIA, or
CAD/stents. Uncorrected
stable
congenital
cardiac
abnormality,
asthma with
exacerbation,
poorly controlled
epilepsy, insulin
dependent
diabetes
mellitus, morbid
obesity,
malnutrition,
severe OSA,
oncologic state,
renal failure,
muscular
dystrophy,
cystic fibrosis,
history of organ
transplantation,
brain/spinal cord
malformation,
symptomatic
hydrocephalus,
premature infant
PCA <60 weeks, autism
with severe
limitations,
metabolic
disease, difficult
airway, long
term parenteral
nutrition. Full
term infants <6
weeks of age. Preeclampsia with severe
features, gestational DM
with complications or high
insulin requirements, a
thrombophilic disease
requiring anticoagulation. IV A patient with severe systemic disease that is constant threat to life Recent (<3
months) MI, CVA,
TIA or CAD/stents,
ongoing cardiac
ischemia or severe valve dysfunction,
severe reduction
of ejection fraction,
shock, sepsis,
DIC, ARD or
ESRD not
undergoing
regularly
scheduled dialysis Symptomatic
congenital
cardiac
abnormality,
congestive heart failure, active
sequelae of
prematurity,
acute hypoxicischemic
encephalopathy,
shock, sepsis,
disseminated
intravascular
coagulation,
automatic
implantable
cardioverter defibrillator,
ventilator
dependence,
endocrinopathy,
severe trauma,
severe
respiratory
distress,
advanced
oncologic state. Preeclampsia with severe
features complicated by
HELLP or other adverse
event, peripartum
cardiomyopathy with EF<40,
uncorrected/decompensated
heart disease, acquired or
congenital. V A moribund patient not expected to survive without surgery 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 Massive trauma,
intracranial
hemorrhage
with mass
effect, patient
requiring
ECMO,
respiratory
failure or arrest,
malignant
hypertension,
decompensated
congestive heart
failure, hepatic
encephalopathy,
ischemic bowel
or multiple
organ/system
dysfunction. Uterine rupture VI A declared brain dead patient whose organs are being removed for donor purposes

Although pregnancy is not a disease, the parturient’ s physiologic state is significantly altered from
when the woman is not pregnant, hence the assignment of ASA 2 for a woman with uncomplicated
pregnancy.
**The addition of “E” denotes Emergency surgery: (An emergency is defined as existing when delay
in treatment of the patient would lead to a significant increase in the threat to life or body part)

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