Aldrete Score

Aldrete score items

The evaluation, also known Post Anesthesia Recovery (PAR), focuses on the following directions:

■ Muscle activity is assessed by observing the patient’s ability to move his extremities, spontaneously or on command. This is helpful in the evaluation of patients with subarachnoid or epidural blocks.

■ Respiratory efficiency reflected the respiratory effort.

■ Circulation is evaluated through systemic blood pressure and compared to the preanesthetic level.

■ Consciousness is reflected by full alertness and ability to answer questions.

■ Tegument color evaluates whether the skin aspect is normal or cyanotic or jaundiced.

Patient stay in PACU is influenced by other variables, not only the above ones. Examples include drugs used for anaesthesia, their half-life and other aspects of general status.

Score interpretation

Each of the five items in the Aldrete score calculator is awarded from 0 to 2 points, depending on the answer chosen in the evaluation. The higher the score, the more likelihood of recovery without need of observation.

Results vary between 0 and 10. Patients with scores of 9 and 10 can be safely discharged from PACU.

Scores of 10 indicate, according to the original study, a patient in the best condition. Scores of 7 and below come with indication of continuous close observation.

About the original study

The original study involved 352 patients, from different institutions, in order to include varied types of anesthesia and operative or diagnostic procedures.

From the results, at the third evaluation, after 2 hours from surgery, 75% of patients attained a score of 10, 16.7% a score of 9 and 8.3% a score of 8.

Where muscle relaxants have been administered along general anesthesia, there were higher percentages of patients with scores of 7 and below. However, the difference between patients given muscle relaxants and those who were not, was nil at the second evaluation (after 1 hour).

It was also observed that the awarding of 0 to one of the physical signs was usually accompanied by a grading of 1 in at least another of the items.

The score was aimed to provide standardization of the recovery room therapeutic measures and interrelatedness between different institutions.

One of the criticisms received by the method is the fact that is universally applied to all types of surgeries. There is argument that post op recovery after one day surgeries should be evaluated differently to that in classical surgeries.

This was the first system of such scoring and is followed by a Modified Aldrete score which includes O₂ saturation in the evaluation.

Dr J. A. Aldrete is a Board Certified Anesthesiologist who has developed the postanesthesia grading system known as the Aldrete Score. He is the creator and President of the Arachnoiditis Foundation Inc. a non-profit organization.

Post-surgery recovery

The primary PACU assessment consists of respiratory evaluation, airways, breathing, respiratory rate and rhythm but also of vital signs and surgical site clinical assessment (in case dressing or draining is required).

Phase I after surgery is the immediate post op phase. This usually takes place at the intensive care level. The patient is yet to be stabilized hemodynamically, appears somnolent and may require supplemental oxygen or pain medication.

Phase II does not have a typical time after which it occurs, as it depends on type of surgery, anesthetic use and patient condition. This is however, the phase in which the clinician is most likely to evaluate and allow the patient to be discharged.

The patient is hemodynamically stable and is in less need for pain medication, assistance or critical care of the surgical site.

Original source

Aldrete JA, Kroulik D. A postanesthetic recovery score. Anesth Analg. 1970; 49(6):924-34.

Other references

1. Aldrete JA. The post-anesthesia recovery score revisited. J Clin Anesth. 1995; 7(1):89-91.

2. Marshall SI, Chung F. Discharge criteria and complications after ambulatory surgery. Anesth Analg. 1999; 88(3):508-17.