Wilkins, 10th Ed.

ASA Determination
W i t h t h e c om p l e t i o n o f t h e p a t i e n t h i s t o r i e s , a n ov e r a l l e s t i m a t e o f m e d i c a l r i s k o f a p a t i e n t c a n b e m a d e . AS A P h ys i c a l S t a t u s
C l a s s i f i c a t i o n S ys t e m ( p a g e 3 6 0 ) wa s a d o p t e d b y t h e A m e r i c a n S o c i e t y o f A n e s t h e s i o l o g i s t s ( A S A ) i n 1 9 6 2 1 4 a n d d e s c r i b e s f i v e
c a t e g o r i e s a s f o l l o ws :

AS A I : A p a t i e n t wi t h o u t a p p a r e n t s y s t e m i c d i s ea s e : a n o r m a l h e a l t h y p a t i e n t .
AS A I I : A p a t i e n t wi t h m i l d s ys t e m i c d i s e a s e .
AS A I I I : A pa t i e n t wi t h s e v e r e s ys t e m i c d i s e a s e t h a t l i m it s ac t i v i t y b u t i s n o t i n c a p a c i t a t i n g .
AS A I V : A p a t i e n t wi t h a n i n c a p a c i t a t i n g s ys t e m i c d is e a s e t ha t i s a c o n s t a n t t h r e a t t o l i f e .
AS A V : A m o r i b u n d p a t i e n t n o t e x p e c t e d t o s u r v iv e 2 4 h o u r s wi t h o r wi t h o u t c a r e .

Table 21-1 ASA Physical Status Classification System

Examples of Physical or Psychosocial Dental Hygiene Treatment

ASA Classification Manifestations Considerations

ASA I Without systemic Able to walk one flight of stairs with no distress No modifications necessary
disease; a normal,
healthy patient
with little or no
dental anxiety

ASA II Mild systemic Must stop after walking one flight of stairs Minimal risk; minor
disease or extreme because of distress modifications to treatment
dental anxiety Well-controlled chronic conditions and/or patient education may be
Age 60+; Healthy pregnant woman necessary
Upper Respiratory infections; Allergies
Slightly Elevated Blood Pressure
140-159/90-94
 Wilkins, 10th Ed.

ASA III Systemic disease Must stop en route walking one flight of stairs Elective treatment is not
that limits activity Chronic cardiovascular conditions; heart attack contraindicated, but serious
but is not or stroke more than 6 months ago consideration of treatment and/or
incapacitating Controlled insulin-dependent diabetes patient/caregiver education
Chronic pulmonary diseases modifications may be necessary
Elevated blood pressure
160-199/95-114

ASA IV Incapacitating Unable to walk up one flight of stairs Conservative, noninvasive

disease that is a Unstable cardiovascular conditions; heart attack management of emergency
DO NOT constant threat to or stroke less than 6 mo ago dental conditions; more complex
PROCEED life Uncontrolled epilepsy dental intervention may require
Uncontrolled insulin-dependent diabetes hospitalization during treatment;
MED Extremely elevated blood pressure caregiver training for daily oral
CONSULT 200/115 + care may be necessary
NEEDED

ASA V Patient is End-stage disease: renal, hepatic, infectious Only palliative treatment is
moribund and not disease, or terminal cancer delivered; caregiver training for
expected to daily oral care may be necessary.
survive

*American Society of Anesthesiologists

Adapted from: Malamed, S. F.: Medical Emergencies in the Dental Office, 5th ed. St. Louis, Mosby, 2000, pp. 4144.