Letter to the Editor  |   June 2015
Obesity and ASA Physical Status
Author Affiliations
  • Jerry Ingrande, M.D.
    Stanford, California
Article Information
Letter to the Editor
Letter to the Editor   |   June 2015
Obesity and ASA Physical Status
ASA Monitor 06 2015, Vol.79, 76.
ASA Monitor 06 2015, Vol.79, 76.
In 1963 the American Society of Anesthesiologists (ASA) published guidelines for grading the physical status (PS) of patients undergoing anesthesia.1  The system was, and is, still intended to be used to standardize assessment of health status and not anesthetic risk. Thus, while an otherwise healthy patient with a severely compromised airway or nearly impossible I.V. access may represent greater anesthetic risk, their proper physical status could still be ASA PS 1.
ASA PS definitions have always been vague so grading is often inconsistent.2 -3  In 2014 the ASA House of Delegates, without changing actual definitions, published examples of conditions that merited assignment to specific ASA PS categories. An otherwise healthy but obese patient (defined as a body mass index (BMI)>30 kg/m2) was used as an example of ASA PS 2 (“a patient with mild systemic disease”), and a morbid obese patient (BMI>40 kg/m2), even without co-existing medical problems, was used as an example of ASA PS 3 (“a patient with severe systemic disease”).4 
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