Pediatrics. 2018 May;141(5). doi: 10.1542/peds.2018-0598. Epub 2018 Apr 23.
This clinical report addresses the topic of pre-existing do not attempt resuscitation or limited resuscitation orders for children and adolescents undergoing anesthesia and surgery. Pertinent considerations for the clinician include the rights of children, decision-making by parents or legally approved representatives, the process of informed consent, and the roles of surgeon and anesthesiologist. A process of re-evaluation of the do not attempt resuscitation orders, called "required reconsideration," should be incorporated into the process of informed consent for surgery and anesthesia, distinguishing between goal-directed and procedure-directed approaches. The child's individual needs are best served by allowing the parent or legally approved representative and involved clinicians to consider whether full resuscitation, limitations based on procedures, or limitations based on goals is most appropriate.
本临床报告涉及接受麻醉和手术的儿童和青少年预先存在的不复苏或有限复苏医嘱的问题。临床医生应考虑到儿童的权利、父母或法定授权代表的决策、知情同意过程以及外科医生和麻醉师的角色。重新评估不复苏医嘱的过程，称为“必须重新考虑”，应纳入手术和麻醉的知情同意过程中，区分目标导向和程序导向的方法。最好允许父母或法定授权代表和相关临床医生考虑是否进行全面复苏、基于程序的限制或基于目标的限制，以满足孩子的个体需求。
