What Should an Anesthesiologist and Surgeon Do When They Disagree About Terms of Perioperative DNR Suspension?

Abstract

This case examines perioperative suspension of a do-notresuscitate (DNR) order during surgery. The commentary considers the appropriateness of DNR orders; types of DNR order suspension in the context of alternative anesthesia techniques; and what is required from a surgeon, anesthesiologist, and patient or surrogate to reach a decision expressing the patient's best interest. It concludes by offering communication recommendations based on joint discussion and decision sharing. Case A 76-year-old woman with dementia, Ms B, is brought to the emergency department after she fell at her nursing home. An X-ray reveals a left femoral neck fracture, and she is seen by an orthopedic consultant, Dr S, who recommends surgical repair.

Physicians' perspectives and attitudes toward surgical bailout in transcatheter aortic valve replacement

“…The authors encouraged a shared responsibility for preoperative code status conversations, intraoperative emergency decision-making, disclosures to family, and postoperative outcomes. 26 , 27 , 28 Recent studies have shown that effective multidisciplinary teamwork improves patient safety and highlights the importance of communication skills. 29…”