Anaesthetic Protocols

Question 1

Outline ASA grading

Answer 1

• ASA I: A normal healthy patient
• ASA II: A patient with mild systemic disease
• ASA III: A patient with severe systemic disease
• ASA IV: A patient with severe systemic disease that is a constant threat to life
• ASA V: A moribund patient who is not expected to survive without the operation
• ASA VI: Declared brain-dead patient whose organs are being removed for donor purposes

Question 2

What are some examples for ASA 2, 3?

Answer 2

ASA II: Mild diseases only without substantive functional limitations.

• Current smoker
• Social alcohol drinker
• Pregnancy
• Obesity (30 < BMI < 40)
• Well-controlled Diabetes Mellitus/Hypertension
• Mild lung disease

ASA III: Substantive functional limitations; One or more moderate to severe diseases.

• Poorly controlled Diabetes Mellitus/Hypertension
• COPD
• Morbid obesity (BMI 40)
• Active hepatitis
• Alcohol dependence or abuse
• Implanted pacemaker, moderate reduction of ejection fraction
• End Stage Renal Disease (ESRD) undergoing regularly scheduled dialysis
• History (>3 months) of Myocardial infarction
• Cerebrovascular accidents

Question 3

What are some examples for ASA 4, 5?

Answer 3

ASA IV

• Recent (< 3 months) of Myocardial infarction
• Cerebrovascular accidents
• Ongoing cardiac ischaemia or severe valve dysfunction
• Severe reduction of ejection fraction
• Sepsis
• DIC, ARD or ESRD not undergoing regularly scheduled dialysis

ASA V

• Ruptured abdominal/thoracic aneurysm
• Massive trauma
• Intra-cranial bleed with mass effect
• Ischaemic bowel in the face of significant cardiac pathology or multiple organ/system dysfunction

Question 4

What are causes of Post Operative Pyrexia?

Answer 4

Early causes of post-op pyrexia (0-5 days) include:

• Blood transfusion
• Cellulitis
• Urinary tract infection
• Physiological systemic inflammatory reaction (usually within a day following the operation)
• Pulmonary atelectasis - this if often listed but the evidence base to support this link is limited

Late causes (>5 days) include:

• Venous thromboembolism
• Pneumonia
• Wound infection