What is the ASA physical status classification for pediatric patients undergoing sedation?

Updated: May 08, 2018
  • Author: Wan-Tsu Wendy Chang, MD; Chief Editor: Ted Rosenkrantz, MD  more...
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The ASA physical status classification was developed for patients undergoing general endotracheal anesthesia. It includes the following classes:

  • I - Normal healthy patient

  • II - Patient with mild systemic disease

  • III - Patient with severe systemic disease

  • IV - Patient with severe systemic disease that is a constant threat to life

  • V - Moribund patient not expected to survive without operation

  • E - Emergent procedure

This classification stratifies the risk of complications from a procedural sedation. Class I and II patients are the best candidates for general endotracheal anesthesia. Whether this classification can be accurately extrapolated for procedural sedation in the ED is unknown.

The existence of a preexisting physical or psychological condition is not an absolute contraindication for procedural sedation. Rather, it should help guide the clinician in carefully selecting the most appropriate medication(s) and route of administration.

Laboratory workup has no role before procedural sedation.

A study that evaluated the impact of obesity on adverse events and required interventions during pediatric procedural sedation found that obesity is an independent risk factor for adverse respiratory events during procedural sedation and is associated with an increased frequency of airway interventions. Extra care and attentiveness should be applied when sedating these patients. [12]

A study set to determine whether critically ill children managed with a nurse-implemented, goal-directed sedation protocol, experience fewer days of mechanical ventilation than patients receiving usual care. The authors concluded that among children undergoing mechanical ventilation for acute respiratory failure, the use of a sedation protocol compared with usual care did not reduce the duration of mechanical ventilation however exploratory analyses of secondary outcomes suggest a complex relationship among wakefulness, pain, and agitation. [13, 14]


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