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Overview :
Peter and Lutz developed an instrument for grading the level
of anesthetic risk for a patient, with a modified version presented by Hussman
and Russell. This can help identify a patient at risk for complications. The
original authors are from Heidelberg University in Germany.
Parameters:
(1) patient status
(2) nature of the operation
(3) age of the patient
(4) body weight
(5) fasting status
(6) consciousness
(7) blood pressure
(8) heart
(9) pulse
(10) respiratory system
(11) renal function
(12) liver function
(13) blood glucose
(14) electrolytes
(15) hydration
(16) hemoglobin
(17) allergies
(18) other major diseases
(19) expected operation time
(20) burns
|
Parameter |
Finding |
Points |
|
status |
"status" (in good shape) |
0 |
|
|
ambulant (? walking wounded) |
1 |
|
|
emergency |
2 |
|
type of operation |
planned, scheduled |
0 |
|
|
urgent |
1 |
|
|
immediate |
2 |
|
age |
0 - 1 years |
1 |
|
|
1 – 39 years |
0 |
|
|
40 – 69 years |
1 |
|
|
70 – 79 years |
2 |
|
|
> 80 years |
4 |
|
weight |
> 50% over |
4 |
|
|
30-50% over |
2 |
|
|
10-30% over |
1 |
|
|
normal (10% over or under) |
0 |
|
|
10-15% under |
1 |
|
|
15-25% under |
2 |
|
|
> 25% under |
4 |
|
fasting |
> 6 hours |
0 |
|
|
1 – 6 hours |
1 |
|
|
< 1 hour |
2 |
|
consciousness |
conscious |
0 |
|
|
drowsy |
1 |
|
|
comatose |
2 |
|
blood pressure |
stable |
0 |
|
|
hypotension |
1 |
|
|
labile hypertension |
2 |
|
|
fixed hypertension |
4 |
|
|
compensated shock |
8 |
|
|
uncompensated shock |
16 |
|
heart |
healthy |
0 |
|
|
compensated heart failure |
1 |
|
|
decreased cardiac function |
2 |
|
|
myocardial infarction < 2 months |
4 |
|
|
heart failure |
8 |
|
|
decompensated heart failure |
16 |
|
pulse |
normal |
0 |
|
|
irregular rhythm |
1 |
|
|
tachycardia |
2 |
|
|
arrhythmias |
2 |
|
|
PVCs |
4 |
|
|
complete AV block |
16 |
|
respirations |
normal |
0 |
|
|
dyspnea |
1 |
|
|
bronchitis |
2 |
|
|
pneumonia |
4 |
|
|
respiratory failure |
8 |
|
renal function |
normal |
0 |
|
|
renal failure |
1 |
|
|
anuria or uremia |
2 |
|
liver function |
normal |
0 |
|
|
liver failure |
1 |
|
|
hepatic coma |
2 |
|
blood sugar |
normal |
0 |
|
|
controlled diabetes |
1 |
|
|
uncontrolled diabetes |
2 |
|
electrolytes |
normal (3 to 5 mmol/L) |
0 |
|
|
hyperkalemia > 5 mmol/L |
1 |
|
|
hypokalemia 2.5 to 2.99 mmol/L |
2 |
|
|
hypokalemia < 2.5 mmol/L |
4 |
|
hydration |
normal |
0 |
|
|
dehydrated |
4 |
|
hemoglobin |
> 12.5 g/dL |
0 |
|
|
7.5 to 12.5 g/dL |
1 |
|
|
< 7.5 g/dL |
2 |
|
allergies |
none |
0 |
|
|
allergies |
1 |
|
other diseases |
none |
0 |
|
|
other severe disease |
2 |
|
anticipated operation time |
<= 120 minutes |
0 |
|
|
121 – 180 minutes |
1 |
|
|
> 180 minutes |
2 |
|
burns |
none |
0 |
|
|
< 15% BSA with no pulmonary |
1 |
|
|
15-50% BSA with no pulmonary |
4 |
|
|
> 50% BSA or pulmonary |
8 |
|
|
> 50% burn and pulmonary |
16 |
where:
• For the
patient status, I am not sure of the correct term for 0 point group.
• There is
overlap for age = 1 year.
• There are
overlaps in the ranges when body weight is 10% and 15% under ideal.
• The
presence of allergy does not take into account anaphylaxis or the number of
relevant allergies.
• I am not
sure how COPD would be handled, unless it would be counted as bronchitis.
• The
handling of "other significant diseases" seems underpowered, especially if more
than one is present, and does not appear to adapt to degree of severity.
• I am a
little confused by the handling of cardiac arrhythmias (incomplete block,
etc.).
•
Dehydration seems scored too high, while other conditions are scored too
low.
Differences from the original form:
(1) The original appeared to have been in 2 parts (first part
through respiration).
(2) Burns was not a separate section.
(3) Scoring of cardiac arrhythmias is slightly different.
risk score =
= SUM(points for all 20 parameters)
Interpretation:
• minimum score: 0
• maximum score: 109
• The higher the score the greater the anesthetic risk.
|
Risk Score |
Risk Group |
|
0 or 1 |
I |
|
2 or 3 |
II |
|
4 to 7 |
III |
|
8 to 15 |
IV |
|
> 15 |
V |
|