Do not resuscitation orders and anesthesia

  • Fritz Eduardo Gempeler-Rueda Department of Anesthesiology, Pontificia Universidad Javeriana, Bogotá, Colombia
  • Ana María de Brigard-Pérez Medical Responsibility Program, Potificia Universidad Javeriana, Bogotá, Colombia
Keywords: Bioethics, Heart arrest, Anesthesiology, Ethics, Cardiopulmonary resuscitation.

Abstract

Given the poor results derived from cardio-pulmonary resuscitation (CPR), some decades ago, so-called do not resuscitate orders were established. These include unilateral medical decisions taken in extreme situations when the survival rate or recuperation of the patient is considered nil. Currently, and given the development of individual guaranties and their adoption in clinical practice, do not resuscitate orders are understood as agreements between physicians and patients (or their legal representatives) to not undertake CPR in the case of cardiac arrest. The definition of the clinical practice limits has slowly been accepted in view of the subsequent results in individuals' lives. However, the compatibility of these decisions -considered restrictive- on patients who will be treated under anesthesia is not yet clear. The purpose of this article is to present a conceptual framework for this dilemma and to provide answers to the formulation, consequences, and implications of do not resuscitate orders in the perianesthesia period.

References

1. Mohr M, Kettler D. Ethical aspects of resuscitation. Br J Anaesth. 1997;79:253-9.
2. McBrien M, Heyburn G. Do not attempt resuscitation orders in the peri-operative period. Anaesthesia. 2006;61:625-7.
3. Gempeler F. Reanimación cardiopulmonar mas allá de la técnica. Rev Colomb Anestesiol. 2015;43:142-6.
4. Angus DC. Successful resuscitation from in-hospital cardiac arrest-what happens next? JAMA. 2015;314:1238-9.
5. Fendler TJ, Spertus JA, Kennedy KF, Chen LM, Perman SM, Chan PS. Alignment of do-not-resuscitate status with patients' likelihood of favorable neurological survival after in-hospital cardiac arrest. JAMA. 2015;314:1264-71.
6. Link MS, Berkow LC, Kudenchuk PJ, Halperin HR, Hess EP, Moitra VK, et al. Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132 Suppl. 2: S444-64.
7. British Medical Association, Resuscitation Council (UK) and Royal College of Nursing. Decisions relating to cardiopulmonary resuscitation. London; October 2014 updated 2015 nov 29 Available from: http://bma.org.uk/-/media/files/pdfs/practical%20advice%20at%20work/ethics/decisionsrelatingresusreport.pdf.
8. Gill R. Decisions relating to cardiopulmonary resuscitation: commentary 1: CPR and the cost of autonomy. J Med Ethics. 2001;27:317-8.
9. Monzon JL, Saralegui R, Molina R, Abizanda R, Cruz Martín M, Cabré L, et al. Ética de las decisiones en resucitación cardiopulmonar. Med Intensiva. 2010;34:534-49.
10. Guarisco KK. Managing do-not-resuscitate orders in the peri anesthesia period. J Perianesth Nurs. 2004;19:300-7.
11. Van Norman G. Do-not-resuscitate orders during anaesthesia and urgent procedures; 1998 updated 2015 nov 29 Available from: https://depts.washington.edu/bioethx/topics/dnrau.html.
12. Fritz Z, Fuld J. Ethical issues surrounding do not attempt resuscitation orders: decisions, discussion and deleterious effects. J Med Ethics. 2010;36:593-7.
13. Association of Anaesthetists of Great Britain and Ireland. Do Not Attempt Resuscitation (DNAR) decisions in the perioperative period. London; 2009 updated 2015 nov 29 Available from: http://www.aagbi.org/sites/default/files/dnar_09_0.pdf.
14 Rothenburg D Informed refusal - DNR orders in the patient undergoing anesthesia and surgery at the end-of-life. In: Van Norman G, editor. Clinical ethics in anaesthesiology: a case based textbook. Cambridge: Cambridge University Press; 2011. p. 13-8.
15. American Society of Anaesthetists Committee on Ethics. Ethical guidelines for the anesthesia care of patients with do-not-resuscitate orders or other directives that limit treatment; 2001 updated 2015 nov 29 Available from: https://www.asahq.org/quality-and-practice-management/standards-and-guidelines Fecha de consulta 29 de Noviembre 2015.
16. Canadian Anesthesiologists' Society Committee on Ethics. Peri-operative status of'do not resuscitate' (DNR) orders and other directives regarding treatment; 2002 updated 2015 nov 29 Available from: https://www.cas.ca/English/Page/Files/97_ethics.pdf Fecha de consulta 29 de Noviembre 2015.
17. Knipe M, Hardman JG. Past, present, and future of 'Do not attempt resuscitation' orders in the perioperative period. Br J Anaesth. 2013;111:861-3.
18. Burns JP, Edwards J, Johnson J, Cassem NH, Truog RD. Do-not-resuscitate order after 25 years. Crit Care Med. 2003;31:1543-50.
19. Cereceda L. Orden de no reanimar, consideraciones sobre este problema. Rev Med Clin Condes. 2011;22:369-76.
20. Sentencia C - 239 de 1997. Corte Constitucional Colombiana. Magistrado Ponente, Carlos Gaviria Díaz. updated 2015 nov 29 Available from: http://www.corteconstitucional.gov.co/relatoria/1997/c-239-97.htm.
21. Sentencia T - 659 de 2012. Corte Constitucional Colombiana. Magistrada Ponente, Dra. Clara Inés Vargas Hernandez. updated 2015 nov 29 Available from: http://www.corteconstitucional.gov.co/relatoria/2002/T-659-02.htm.
How to Cite
1.
Gempeler-Rueda FE, de Brigard-Pérez AM. Do not resuscitation orders and anesthesia. Colomb. J. Anesthesiol. [Internet]. 2016 Apr. 1 [cited 2024 Mar. 28];44(2):146–150. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/476

Downloads

Download data is not yet available.
Published
2016-04-01
How to Cite
1.
Gempeler-Rueda FE, de Brigard-Pérez AM. Do not resuscitation orders and anesthesia. Colomb. J. Anesthesiol. [Internet]. 2016 Apr. 1 [cited 2024 Mar. 28];44(2):146–150. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/476
Section
Essay

Altmetric

Article metrics
Abstract views
Galley vies
PDF Views
HTML views
Other views
QR Code