Sedation Scales: Ramsay, RASS and SAS.

The following scales are often used in sedated patients to assess the degree of sedation or agitation.


Ramsay Sedation Scale

1Patient is anxious and agitated or restless, or both
2Patient is co-operative, oriented, and tranquil
3Patient responds to commands only
4Patient exhibits brisk response to light glabellar tap or loud auditory stimulus
5Patient exhibits a sluggish response to light glabellar tap or loud auditory stimulus
6Patient exhibits no response

Richmond Agitation Sedation Scale (RASS)

+4CombativeOvertly combative, violent, immediate danger to staff
+3Very agitatedPulls or removes tube(s) or catheter(s); aggressive
+2AgitatedFrequent non-purposeful movement, fights ventilator
+1RestlessAnxious but movements not aggressive vigorous
0Alert and calm
-1DrowsyNot fully alert, but has sustained awakening
(eye-opening/eye contact) to voice (>10 seconds)
-2Light sedationBriefly awakens with eye contact to voice (<10 seconds)
-3Moderate sedationMovement or eye opening to voice (but no eye contact)
-4Deep sedationNo response to voice, but movement or eye opening to physical stimulation
-5UnarousableNo response to voice or physical stimulation communicate or follow commands

Riker Sedation-Agitation Scale (SAS)

7DangerousPulling at ET tube, trying to remove catheters, climbing over bedrail, striking at staff, thrashing side-to-side
6Very agitatedRequiring restraint and frequent verbal reminding of limits, biting ETT
5AgitatedAnxious or physically agitated, calms to verbal instructions
4Calm and CooperativeCalm, easily arousable, follows commands
3SedatedDifficult to arouse but awakens to verbal stimuli or gentle shaking, follows simple commands but drifts off again
2Very SedatedArouses to physical stimuli but does not communicate or follow commands, may move spontaneously
1UnarousableMinimal or no response to noxious stimuli, does not
communicate or follow commands


  1. Validating the Sedation-Agitation Scale with the bispectral index and visual analog scale in adult ICU patients after cardiac surgery. Riker RR, Fraser GL, Simmons LE, Wilkins ML. Intensive Care Med 2001; 27:853-858.
  2. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O’Neal PV, Keane KA, Tesoro EP, Elswick RK. Am J Respir Crit Care Med. 2002 Nov 15;166(10):1338-44.
  3. Ramsay Sedation Scale. Available at the Stanford Palliative Care Website.
  4. Comparison and agreement between the Richmond Agitation-Sedation Scale and the Riker Sedation-Agitation Scale in evaluating patients’ eligibility for delirium assessment in the ICU. Khan BA, Guzman O, Campbell NL, Walroth T, Tricker J, Hui SL, Perkins A, Zawahiri M, Buckley JD, Farber MO, Ely W, Boustani MA. Chest. 2012 Jul;142(1):48-54.