Department of Anesthesiology, Division of Critical Care Medicine, Virginia Commonwealth University, Richmond, Virginia.
Department of Anesthesiology and Critical Care Medicine, The George Washington University, Washington, DC, USA.
Curr Opin Anaesthesiol. 2021 Apr 1;34(2):141-144. doi: 10.1097/ACO.0000000000000974.
Addressing patients' Do Not Resuscitate (DNR) status in the perioperative setting is important for shared patient decision-making. Although the inherently resuscitative nature of anesthesia and surgery may pose an ethical quandary for clinicians tasked with caring for the patient, anesthesiologist-led efforts need to evaluate all aspects of the DNR order and operative procedures.
Approximately 15% of patients undergoing surgical procedures have a preexisting DNR order (Margolis et al., 1995) [1]. American Society of Anesthesiologists (ASA) and the American College of Surgeons (ACS) do not support automatic reversal of the DNR order in the perioperative setting. Citing patient self-determination and autonomy, these societies advocate for a thoughtful discussion where a patient or legal designee may make an informed decision regarding resuscitation in the perioperative setting. Although studies have suggested increased perioperative mortality among patients with a preexisting DNR order, this data remains largely inconclusive.
Efforts must be made to address the DNR order in the perioperative setting. The fundamental tenets of medical ethics, nonmaleficence, beneficence, and patient autonomy can help to guide this oftentimes challenging discussion.
在围手术期解决患者的“不复苏”（Do Not Resuscitate，DNR）状态对于共同做出患者决策非常重要。尽管麻醉和手术固有的复苏性质可能给负责照顾患者的临床医生带来伦理困境，但麻醉师主导的努力需要评估 DNR 医嘱和手术操作的所有方面。
大约 15%接受手术的患者有预先存在的 DNR 医嘱（Margolis 等人，1995 年）[1]。美国麻醉师协会（American Society of Anesthesiologists，ASA）和美国外科医师学会（American College of Surgeons，ACS）不支持在围手术期自动撤销 DNR 医嘱。这些协会援引患者的自我决定和自主权，主张进行深思熟虑的讨论，让患者或法定代理人在围手术期就复苏做出明智的决定。尽管研究表明，预先存在 DNR 医嘱的患者围手术期死亡率增加，但这些数据仍存在很大的不确定性。
必须努力在围手术期解决 DNR 医嘱问题。医学伦理学的基本原则，如不伤害、有益和患者自主权，可以帮助指导这一常常具有挑战性的讨论。
