The Do Not Resuscitate (DNR) order in the perioperative setting: practical considerations. Issue 2 (23rd April 2021)

• Record Type: Journal Article
• Authors: Kim, Christin; Keneally, Ryan
• Is Part Of: Current opinion in anaesthesiology. Volume 34:Issue 2(2021)
• Page Start: 141
• Page End: 144
• Publication Date: 2021-04-23
• Subjects: Do Not Resuscitate -- medical ethics -- patient autonomy -- perioperative resuscitation; Anesthesiology -- Periodicals; Anesthesiology -- Indexes; Anesthesiology -- Periodicals; Review Literature -- Indexes; Review Literature -- Periodicals; Anesthesiology; Periodicals; 617.9605
• DOI: 10.1097/ACO.0000000000000974
• Languages: English
• ISSNs: 0952-7907

Abstract

Abstract : Purpose of review: Addressing patients' Do Not Resuscitate (DNR) status in the perioperative setting is important for shared patient decision-making. Although the inherently resuscitative nature of anesthesia and surgery may pose an ethical quandary for clinicians tasked with caring for the patient, anesthesiologist-led efforts need to evaluate all aspects of the DNR order and operative procedures. Recent findings: Approximately 15% of patients undergoing surgical procedures have a preexisting DNR order (Margolis et al ., 1995) [1]. American Society of Anesthesiologists (ASA) and the American College of Surgeons (ACS) do not support automatic reversal of the DNR order in the perioperative setting. Citing patient self-determination and autonomy, these societies advocate for a thoughtful discussion where a patient or legal designee may make an informed decision regarding resuscitation in the perioperative setting. Although studies have suggested increased perioperative mortality among patients with a preexisting DNR order, this data remains largely inconclusive. Summary: Efforts must be made to address the DNR order in the perioperative setting. The fundamental tenets of medical ethics, nonmaleficence, beneficence, and patient autonomy can help to guide this oftentimes challenging discussion.