Clarification: RS Criteria vs. Ramsay Sedation Scale
The question appears to contain a misunderstanding: there are no "RS criteria" for preoperative assessment in standard perioperative guidelines. If you are asking about the Ramsay Sedation Scale (RSS), this is a tool used to assess depth of sedation during procedures or in the ICU, not a preoperative risk assessment tool. 1
If You Mean Preoperative Risk Assessment
For preoperative cardiovascular evaluation, the ACC/AHA guidelines recommend a stepwise approach based on clinical risk factors, functional capacity, and surgery-specific risk—not the Ramsay Sedation Scale. 1
Key Components of Preoperative Assessment:
Active cardiac conditions screening: Identify unstable coronary syndromes, decompensated heart failure, significant arrhythmias, and severe valvular disease before proceeding with noncardiac surgery 1
Functional capacity assessment: Determine if the patient can achieve ≥4 METs (climb 2 flights of stairs without symptoms) 1, 2
Clinical risk factors: Evaluate for coronary heart disease, heart failure, cerebrovascular disease, diabetes mellitus, and renal impairment 1
Surgery-specific risk stratification: Classify procedures as low-risk (<1% MACE), intermediate-risk, or high-risk (vascular surgery) 1, 2
Selective testing only: No test should be performed unless it will influence patient treatment 1
Testing Recommendations Based on Risk:
Low-risk surgery: No routine preoperative ECG, laboratory tests, or cardiac stress testing for asymptomatic patients 1, 2
Intermediate/high-risk surgery with risk factors: Preoperative 12-lead ECG for patients with known coronary disease, peripheral arterial disease, or cerebrovascular disease 1
Laboratory testing: Reserved for patients at specific risk (anemia, renal impairment, electrolyte abnormalities, coagulopathy) based on history and medications 1, 3
If You Mean the Ramsay Sedation Scale Itself
The Ramsay Sedation Scale is a 6-point scale used to monitor sedation depth during procedures or in the ICU, not for preoperative risk assessment. 4, 5, 6
Ramsay Sedation Scale Levels:
- Level 1: Anxious, agitated, or restless 4, 6
- Level 2: Cooperative, oriented, and tranquil 4, 6
- Level 3: Responds to commands only 4, 6
- Level 4: Brisk response to light glabellar tap or loud auditory stimulus 4, 6
- Level 5: Sluggish response to light glabellar tap or loud auditory stimulus 4, 6
- Level 6: No response to stimulation 4, 6
Clinical Context:
Target sedation: Typically Ramsay 2-4 for adequate sedation during procedures under spinal anesthesia 4, 6
Deep sedation: Ramsay >4 correlates with increased mortality risk in ICU patients 6
Correlation with other scales: RSS correlates highly with Richmond Agitation-Sedation Scale (RASS) (r = -0.78 to -0.664) and Riker Sedation-Agitation Scale (r = -0.656) 7, 6, 8
Common Pitfall:
Do not confuse sedation monitoring scales (Ramsay, RASS) with preoperative cardiac risk assessment tools (Revised Cardiac Risk Index, ACC/AHA stepwise algorithm). These serve entirely different purposes in perioperative care. 1, 4, 7