Criteria for Referrals

Criteria for Referrals

Relative analgesia is ideally for Children over the age of 5yrs and under 18yrs.
Children under 5yrs of age should be referred to a hospital environment.
Adults may also be offered Relative Analgesia.
Intravenous sedation is for patients 18yrs of age or over.

Please asses the medical status of your patient, prior to their referral. Patients with a very complex medical history, with multiple co-morbidities, such as uncontrolled diabetes, severe unstable angina, severe motor neuron disease, or pregnant patients, should preferably be referred to a hospital environment.

Patients within ASA I and II would normally be seen. See classification attached.

Definition Examples, including, but not limited to:
ASA I A normal healthy patient Healthy, non-smoking, no or minimal alcohol use
ASA II A patient with mild systemic disease Mild diseases only without substantive functional limitations. Examples include (but not limited to): current smoker, social alcohol drinker, pregnancy, obesity (30 < BMI < 40), well-controlled DM/HTN, mild lung disease
ASA III A patient with severe systemic disease Substantive functional limitations; One or more moderate to severe diseases. Examples include (but not limited to): poorly controlled DM or HTN, COPD, morbid obesity (BMI ≥40), active hepatitis, alcohol dependence or abuse, implanted pacemaker, moderate reduction of ejection fraction, ESRD undergoing regularly scheduled dialysis, premature infant PCA < 60 weeks, history (>3 months) of MI, CVA, TIA, or CAD/stents.
ASA IV A patient with severe systemic disease that is a constant threat to life Examples include (but not limited to): recent ( < 3 months) MI, CVA, TIA, or CAD/stents, ongoing cardiac ischemia or severe valve dysfunction, severe reduction of ejection fraction, sepsis, DIC, ARD or ESRD not undergoing regularly scheduled dialysis