Canadian Journal of Anesthesia, Vol 43, 840-851, Copyright © 1996 by Canadian Anesthesiologists' Society

ARTICLES

Do not resuscitate orders in the operating room

DB Craig
Department of Anesthesia, University of Manitoba and Health Sciences Centre, Winnipeg, Manitoba.

PURPOSE: The background to a current analysis of the management of "do not resuscitate" (DNR) orders in the operating room is reviewed, with an emphasis on the current status of resuscitation/DNR issues in Canada. SOURCE: The Joint Statement on Resuscitative Interventions published by the Canadian Medical Association and cooperating organizations and the report of the Senate of Canada Special Committee on Euthanasia and Assisted Suicide are examined for information relevant to the DNR issue. Guidelines on the management of DNR orders in the operating room, published by the American Society of Anesthesiologists and the American College of Surgeons are used to provide a perioperative DNR order management approach consistent with the Joint Statement on Resuscitative Interventions. PRINCIPAL FINDINGS AND CONCLUSIONS: The dominant principle is that of the patient's right to self determination. This right can be exercised either directly by the patient, or through an appropriate alternate, or in the form of an advance directive. DNR orders are not incompatible with subsequent surgical care in an operating room. It is wrong to suspend automatically DNR orders in the perioperative period. It is wrong to continue DNR orders automatically in the perioperative period. It is wrong to make assumptions about the meaning of an individual DNR order. An appropriate approach to the perioperative management of pre-existing DNR orders is one based on "required reconsideration." All anaesthetists must be aware of their responsibilities in managing patients with DNR orders in place.