Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Anesthesiology. 2024 Sep 1;141(3):584-597. doi: 10.1097/ALN.0000000000005107.
The American Society of Anesthesiologists (ASA) opposes automatic reversal of do-not-resuscitate orders during the perioperative period, instead advocating for a goal-directed approach that aligns decision-making with patients' priorities and clinical circumstances. Implementation of ASA guidelines continues to face significant barriers including time constraints, lack of longitudinal relationships with patients, and difficulty translating goal-focused discussion into concrete clinical plans. These challenges mirror those of advance care planning more generally, suggesting a need for novel frameworks for serious illness communication and patient-centered decision-making. This review considers ASA guidelines in the context of ongoing transitions to serious illness communication and increasingly multidisciplinary perioperative care. It aims to provide practical guidance for the practicing anesthesiologist while also acknowledging the complexity of decision-making, considering limitations inherent to anesthesiologists' role, and outlining a need to conceptualize delivery of ethically informed care as a collaborative, multidisciplinary endeavor.
美国麻醉医师学会（ASA）反对在围手术期自动逆转“不复苏”医嘱，而是提倡采用目标导向的方法，使决策与患者的优先事项和临床情况保持一致。ASA 指南的实施仍然面临重大障碍，包括时间限制、与患者缺乏纵向关系以及将目标为导向的讨论转化为具体临床计划的困难。这些挑战与更广泛的预先医疗指示计划的挑战相似，这表明需要用于重病沟通和以患者为中心的决策的新框架。这篇综述在向重病沟通不断转变和围手术期护理日益多学科化的背景下考虑 ASA 指南。它旨在为执业麻醉师提供实用指导，同时也承认决策的复杂性，考虑到麻醉师角色固有的局限性，并概述了将知情伦理护理的提供概念化为协作的、多学科的努力的必要性。
