Adult Perianesthesia Do Not Resuscitate Orders: A Systematic Review

Strategies for Collaborative Consideration of Patients' Resuscitation Preferences

“…For these reasons, an argument can be made that any patient with a preoperative DNR logically should not receive anesthesia. 8 With the introduction of the Patient Self Determination Act in 1990, the anesthesia community began to gradually reconsider how to handle patients with a DNR order in the perioperative setting. Initially, patients and surrogate decision makers were presented with options of either rescinding the DNR or keeping it in place.…”

“…Seventy-five percent of surgeons surveyed by Burkle et al felt that active DNR orders didn't make sense during surgical procedures, and many surgeons held a fixed presumption that patients are all in for the duration of the perioperative period (ie, that DNR orders should automatically be suspended during surgery). 8 These and other beliefs 26 have direct consequences for surgeon behavior, including (1) unwillingness to operate on patients who set boundaries on postoperative interventions and (2) refusal to withdraw life-sustaining treatments.…”

“…2,7 For these reasons, a comprehensive review concluded that it is unethical to automatically rescind such orders. 8 When an anesthesiologist or surgeon discusses a patient's perioperative DNR order with the patient or surrogate decision maker, it is referred to as a required reconsideration discussion. Data show that implementation of required reconsideration during the perioperative period has been slow, 9 although it has been recommended in professional society statements, including those of the American Society of Anesthesiologists (ASA), 10 the American College of Surgeons (ACS), and the Association of Perioperative Registered Nurses (AORN).…”