Hey everyone, I'm Prateek, a dentist and specialty doctor and in this video we're going to be looking
at the ASA classification. If you want to see similar educational content to this please
make sure to subscribe to the channel and head over to Instagram to follow the dentalnotebook
account. The ASA classification was developed by the American society of Anesthesiologists and is
a physical status classification that is used to assess and communicate a patient's pre-anaesthetic
comorbidities. It is a very widely and commonly used method for this purpose and is standardised across
most of medicine. By getting an ASA class we can then effectively predict and potentially mitigate
complications that a patient may experience perioperatively. It's been used for over 60
years with the latest revision happening in 2014 and the classification runs from a score of 1 to 6.
The higher the number, the greater the risk of complications associated with
anaesthesia. Although the ASA classification was started off as a method of assessing
risk with anaesthesia, it has now broadly become a method of communicating a patient's general health
status in dentistry. The ASA classification amongst a few other reasons is most commonly used when it
comes to assessing patients prior to sedation and general anaesthetics. So if we work through
the classification. We have ASA 1 - this is a patient who essentially has no medical problems whatsoever.
They're fit and healthy, they don't smoke, minimal or no alcohol and they have a BMI less than 30.
It's relatively rare actually to find someone who is an ASA 1. We then have ASA 2 which is probably
most common of all of the classes and this describes a patient with mild systemic disease.
So someone who has a condition but it doesn't have any functional limitations. This includes patients
who are active smokers, BMIs between 30 and 40, pregnant patients, social alcohol consumption,
patients have well controlled conditions such as well-controlled diabetes, well-controlled
hypertension, well-controlled epilepsy. And when we mention well-controlled diabetes, we rely on the
HbA1c for this. So remember the HbA1c is one of the methods that diabetics use to monitor their
blood glucose and anything less than seven is someone who's got quite a well controlled
blood glucose level. With ASA 2 patients, we may have to consider making small adaptations to
the work that we're going to do. Generally ASA 1 and 2 patients are safe to be treated in primary
care settings. ASA 3 describes severe systemic disease so this is disease that may lead to
functional limitations but isn't incapacitating so includes poorly controlled conditions such
as poorly controlled diabetes, poorly controlled asthma, poorly controlled hypertension or epilepsy.
It also includes COPD, a patient who has had MI, a stroke or a TIA more than three months
ago and it also includes patients who have a high BMI so those who have a BMI over 40. With
these patients we are more likely to consider carrying out changes to how we're managing them.
We then have ASA 4 patients ASA 4 patients are those who have a severe systemic disease that is
a constant threat to life. So this would include poorly controlled COPD, patients with a recent MI,
stroke or TIA within the last three months, patients who are septic or even patients with
unstable angina, which is brought on without a stimulus. In these types of patients elective
treatment should be avoided and where treatment is necessary it should be referred to a hospital.
ASA 5 describes a moribund patient who will not survive without the operation or intervention so
this includes patients who have ruptured aneurysms or potentially been in massive trauma. And finally
we have ASA 6. ASA 6 describes a patient who has been declared brain dead but whose organs are
being removed for donor purposes. So there we've looked at the ASA classification going from one to
six, now let's look at a couple of quick examples to see how we can apply the classification. So our
first example is a 46 year old male who attends for a filling. They have a medical background of
type 2 diabetes and asthma and they smoke around 5 cigarettes a day. The HbA1c is five percent and
they rarely require their salbutamol inhaler. So we've got a couple of things going on but very
quickly we can determine an ASA classification for this patient. Firstly, they're a type 2 diabetic
however the HbA1c is 5 which tells us that it's well controlled. They're also asthmatic
but they rarely use a salbutamol inhaler so again this is well controlled and there is smoker. All
of these factors - a well controlled diabetic, well controlled asthmatic and an active smoker,
fall into an ASA 2 category. Let's look at another example we have a 47 year
old female who attends for a checkup. She has a medical background diabetes and heart problems.
She tells you she had a heart attack two months ago. Her BMI is 33 and her HbA1c is 6. So let's
break this down again similar to the last example. The patient is a diabetic and the HbA1c is six
percent so this is well controlled diabetes this would put them into an ASA 2 category.
They also have a BMI of 33. Again this would be an ASA 2 patient. However, the fact that is important
to us in this example is that the patient had a myocardial infarction two months ago and therefore
this immediately puts them into an ASA 4 category. This is severe disease that is a constant threat
to life. So I hope you found this video useful and the summary of the ASA classification helpful.
It's a very quick and effective way to communicate even between specialties and like I said it's
widely used around the medical world and having that standardised method of evaluation for a
patient makes it a lot easier to communicate the patient's general health. If you did find the
video useful please make sure to like, comment and subscribe. Until the next video - take care!