Modification of the Anesthetic Risk Assessment by Peter and Lutz

Description

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

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Description

Specialty

Objective

ICD-10

Modification of the Anesthetic Risk Assessment by Peter and Lutz

Purpose: To estimate a patient's anesthetic risk using a modification of the score described by Peter and Lutz.

Description

Specialty

Objective

ICD-10