Scoring Systems

in Anesthesia / PACU
Nabila Jasmine
1410312088

Preseptor:
dr. Emilzon Taslim, Sp.An,
KAO, M.Kes
American Society of Anesthesiologists
Physiological Status Classification

Operative Risk

1941 → 2014

Cannot serve
as a direct
indicator
2
Apfel Score for Post Operative Nausea and Vomiting Female

Koivuranta et al.’s Non-smoking

Risk Score Variables
30 – 80% History of
PONV
History of
motion
sickness
Duration >60
min

N Risk %
POVOC
Score 0 17
Duration
≥30 min 1 18
Variables
2 42
Age ≥3 yr
3 54
N Risk %
4 74
0 9 Strabismus
5 87
1 10
History of
2 30 POV
3 55
4 70 3
Pain Scales

Pain

Rest Dynamic

4
 Sedation Scales

▰Other sedation scales:

- Ramsay Sedation
Scale (RSS)
- Richmond
Agitation-sedation
Scale (RASS)
▰Pasero Opioid-induced Sedation Scale
(POSS)
Aldrete’s Scoring System

Safe
PARS
Discharge

Suggested Score of 9
Criteria or greater
6
 Original 1970 Version Modified 1995 Version (by author)
Activity - Able to move 4 extremities voluntarily or on
command (2 points)
- Able to move 2 extremities (1)
- Unable (0)
Respiration - Able to breathe deeply and cough freely (2)
- Dyspnea or limited breathing (1)
- Apneic (0)
Circulation - BP ±20% of pre-anesthetic level (2)
- BP ±20-49% (1)
- BP ±50% (0)
Consciousness - Fully awake (2)
- Aroused on calling (1)
- Not responding (0)
Colour or O2 - Normal (2) - Able to maintain SpO2 >92% on room air (2)
Saturation - Pale, dusky, blotchy, jaundiced, or other (1) - Needs supplementary O2 to maintain SpO2
- Cyanotic (0) >90% (1)
- SpO2 <90% despite supplementary O2 (0)
Limitations

▰Most departments have a minimum criterion in each

category but this is not in the original scoring system
▰No time limit is dictated in the original paper
▰Some limitations in this scoring system come from
premorbid conditions
▰Activity (limb movement) will be affected by regional or
caudal anesthesia
▰Temperature, urine output, oral intake, blood results, and
psychomotor testing are not included
4
Modified Aldrete’s Score

▰Adopted by various hospitals, including Standford

Hospital and Clinics

▰Circulation → additional criteria → heart rate

▰Activity → 1 point is assigned if the patient is able to
move 3 extremities
▰Pain scale
▰Minimum scores for each category
▰Additional measures for certain conditions 9
 Aldrete’s Score for Ambulatory Patients

Category Criteria
Dressing - Dry and clean (2 points)
- Wet but stationary or marked (1)
- Growing area of wetness (0)
Pain - Pain free (2)
- Mild pain handled by oral medication (1)
- Severe pain requiring parenteral medication (0)
Ambulation - Able to stand up and walk straight* (2)
- Vertigo when erect (1)
- Dizziness when supine (0)
Fasting- - Able to drink fluids (2)
feeding - Nauseated (1)
- Nausea and vomiting (0)
Urine Output - Has voided (2)
- Unable to void but comfortable (1)
- Unable to void and uncomfortable (0) 10
Alternative & Additional Scoring Systems

▰White 1999 → “fast-track criteria” → determine if patients can be

transferred straight to Phase II recovery. 7 categories, minimum
overall score of 12 with no score <1 in any category

▰Post Anesthetic Discharge Scoring System (PADSS) used by

Chung et al. in 1995

▰Discharge criteria tool used by Brown et al. 2008

▰DASAIM discharge assessment tool used by Gartner et al. 2010 11

Steward’s Score

The Simplified Simple record of

PARS important stages
Consciousness of recovery from GA

Commonly RSUP Dr.

used for
assessing M. Djamil Padang:
children score of ≥5

12
Steward’s Score

Category Indicators Points

Consciousness Awake 2
Responding to stimuli 1
Not responding 0
Airway Coughing on command or crying 2
Maintaining good airway 1
Airway requires maintenance 0
Movement Moving limbs purposefully 2
Non-purposeful movements 1
Not moving 0

13
Bromage Scale

To assess the intensity of Ideally used:

motor block on patients - 4 hourly
who underwent spinal
anesthesia - In the RR following surgery
- On return to the ward / unit
- At commencement of each nursing shift
Implemented at
- Prior to ambulation
RSUP M. Djamil Padang:
- 1 hour after a bolus or increase in the
≤ 2 can be discharged infusion rate
from the PACU 14
Bromage Scale

Grade Criteria Degree of Block Score

I Free movement of legs and Nil (0%) 0

feet
II Just able to flex knees with Partial (33%) 1
free movement of feet

III Unable to flex knees, but with Almost complete 2

free movement of feet (66%)

IV Unable to move legs or feet Complete 3

(100%)

15
TERIMA KASIH