Risk Assessment Systems in Anesthesia: NARCO-SS, ASA-PS, and JHSRCS

Risk assessment plays a vital role in healthcare to ensure patient safety and tailor medical care to individual needs. Several risk assessment systems have been developed, each with its own scoring system, to categorize patients’ preoperative and intraoperative risks. In this article, we will explore three such systems: NARCO-SS, ASA-PS, and JHSRCS, along with their respective scoring mechanisms, histories, advantages, and disadvantages.

Certainly, I can include ASA-PS Class 6 in the content. Here’s the revised information with ASA-PS Class 6:

NARCO-SS (Neurological, Airway, Respiratory, Cardiac, and Other Surgical Severity):

Neurological (N)0 – 30: No neurological issues, 3: Severe impairment
Airway (A)0 – 30: Easy intubation, 3: Difficult intubation
Respiratory (R)0 – 30: Normal, 3: Severe respiratory compromise
Cardiac (C)0 – 30: Normal, 3: Severe cardiac dysfunction
Other Items (O)VariesAdditional factors impacting anesthesia/surgery
Surgical Severity (SS)A or BA: Less invasive, B: More invasive
  • Overall Risk Score: Combines N, A, R, C, O, and SS scores to determine the overall risk:
  • Low: Lower risk
  • Moderate: Moderate risk
  • High: Higher risk
  • Higher: Highest risk

ASA-PS (American Society of Anesthesiologists Physical Status):

Class INo systemic disease, normal and healthy
Class IIMild systemic disease, not limiting activity
Class IIISevere systemic disease, limits activity
Class IVIncapacitating disease, constant threat to life
Class VMoribund, not expected to survive 24 hours
Class VIBrain-dead, organ donor
Class EAdded in emergencies, denotes an emergency operation

JHSRCS (Johns Hopkins Surgery Risk Classification System):

Class 1Noninvasive procedures, minimal risk
Class 2Limited invasiveness, mild risk
Class 3More invasive procedures, moderate risk
Class 4Highly invasive procedures, significant risk

Understanding these scores and their corresponding grades in each system allows anesthesiologists to assess a patient’s risk profile more accurately, including the potential for organ donation. It helps in tailoring anesthesia, postoperative care, and making informed decisions regarding the level of care needed.


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