Nursing care
Aldrete score: the five PACU discharge criteria and how to score a recovering patient
Written and reviewed by Nicole Ramirez, BSN, RN, CMSRN · 4 min read · Updated November 2026
Short answer
The modified Aldrete score rates five areas after anesthesia: activity, respiration, circulation, consciousness and oxygen saturation, each 0 to 2, for a total of 10. A score of 9 or more is generally considered ready for PACU discharge. A patient scoring 8 stays for more monitoring and treatment of whichever criterion fell short.
The five Aldrete criteria and how each is scored
Jorge Aldrete published the original score in 1970, using skin color as a stand-in for oxygenation. The 1995 modified version swapped color for pulse oximetry and kept the other four areas. The table summarizes the modified criteria as described in a 2024 review.
| Criterion | 2 points | 1 point | 0 points |
|---|---|---|---|
| Activity | Moves all four limbs on request or voluntarily | Moves two limbs | Cannot move limbs |
| Respiration | Breathes deeply and coughs freely | Shallow breathing or dyspnea | Apneic |
| Circulation | BP within 20% of the preanesthetic level | BP 20% to 49% away from preanesthetic level | BP more than 49% away from preanesthetic level |
| Consciousness | Fully awake | Arousable when called | Unresponsive |
| Oxygen saturation | Above 92% on room air | Needs supplemental oxygen to stay above 90% | Below 90% even with oxygen |
Circulation is judged against the patient's own preoperative blood pressure, not against a normal range. That is why the baseline recorded before surgery matters at the bedside and in exam stems.
Worked example: a patient who scores 8
Hypothetical practice patient, not an order set: a 58-year-old is 40 minutes out of general anesthesia for a laparoscopic cholecystectomy. Preoperative blood pressure was 140/80. She is awake and talking, moves all limbs, breathes deeply and coughs on request, now has a blood pressure of 98/60, and her SpO2 is 94% on 2 L of nasal cannula oxygen.
Worked example
- Activity: moves all four limbs = 2
- Respiration: deep breaths and effective cough = 2
- Circulation: systolic 98 vs baseline 140 is 30% lower, inside the 20% to 49% band = 1
- Consciousness: fully awake = 2
- Oxygen saturation: needs oxygen to keep SpO2 above 90% = 1
- Add: 2 + 2 + 1 + 2 + 1 = 8
The two points she lost tell you where to look. A 30% fall in systolic pressure after abdominal surgery raises questions about bleeding, fluid status and analgesic effects, so trend vital signs and inspect the port sites before simply waiting for the number to rise.
What the Aldrete score does not measure
A 2026 Cureus comparison notes that the modified Aldrete score assesses physiological recovery but does not directly assess pain or postoperative nausea and vomiting. A patient can score 10 while vomiting or in severe pain, which is why the White fast-track score adds pain and emetic symptoms to the physiologic items.
The activity item also behaves oddly after spinal or epidural anesthesia. A patient whose legs are still blocked cannot score 2 on activity even if every vital sign is stable, so many units use additional criteria, such as return of sensation and movement, under local protocol. On an exam, read a low activity score in that context as an expected effect of the block rather than an emergency.
Exam reasoning around the discharge threshold
Hypothetical question, not a real exam item: which PACU client is ready for transfer? A client scoring 10 who rates pain 9 of 10, a client scoring 9 with stable vital signs and controlled pain, or a client scoring 8 who is drowsy but arousable. The 9 with controlled pain is the best fit, because the 10 has an untreated problem the score cannot see.
Another common error is reading the threshold as fixed time in the PACU. Recovery scores replaced purely time-based discharge rules, so a client who reaches 9 earlier may be ready, while one who has been there two hours but scores 7 is not. Always pair the number with the full assessment.
Sources and further reading
Post-Anesthesia Recovery: A Comprehensive Review of Sampe, Modified Aldrete, and White Scoring Systems (Cureus, 2024). Original 1970 and modified 1995 Aldrete scores, five criteria scored 0 to 2, item definitions including BP within 20% and SpO2 thresholds, score of 9 or more for PACU discharge.
Comparison of the Modified Aldrete Score and White Fast-Track Score in PACU Discharge Readiness (Cureus, 2026). Score of 9 or greater for discharge, modified Aldrete does not directly assess pain or nausea and vomiting, White fast-track score adds them, recovery scores replacing time-based discharge.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our med-surg practice questions are the closest set to what this page covers.
One question from the med-surg set
A client with chronic obstructive pulmonary disease has an oxygen saturation of 88% on 2 L/min via nasal cannula and is alert with no distress. What should the nurse do first?
Rationale
In COPD a saturation of 88–92% is the therapeutic target, not an emergency, and this client is alert with no distress. The first action is the independent nursing intervention that is least invasive and most likely to help: sit them up and reassess. Turning the oxygen up to 6 L/min risks blunting the hypoxic drive, and calling rapid response or drawing an ABG escalates ahead of an assessment you have not finished.
Answer: B
Common questions
What Aldrete score is needed for PACU discharge?
A total of 9 or more out of 10 is generally considered adequate for discharge from the PACU, in both the original and modified versions. Facilities add their own criteria, such as pain control, nausea and recovery from a spinal block.
What are the 5 Aldrete criteria?
Activity, respiration, circulation, consciousness and oxygen saturation. The original 1970 version used skin color instead of oxygen saturation; the 1995 modification replaced color with pulse oximetry.
What does an Aldrete score of 8 mean?
It means the patient is not yet ready for PACU discharge by the usual threshold. Identify which criteria lost points, such as low blood pressure compared with baseline or an oxygen requirement, treat and monitor, then rescore.
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