Clark G D, Lucas K, Stephens L
AANA J. 1994 Jun;62(3):253-6.
The growing geriatric population in this country makes it increasingly difficult to deal with the number of do-not-resuscitate (DNR) orders. In part, this is due to an increase in the number of elderly undergoing anesthesia and surgery. It can also be attributed to a rise in complex legal, ethical, and moral issues these orders pose for the healthcare professional caring for the DNR patients, including anesthetists. The term "DNR" is confusing to many, including healthcare professionals. As patients progress through the perioperative period, this confusion is compounded by the fact that administration of anesthesia encompasses interventions that include intubation, ventilation, and fluid replacement. These interventions may be regarded as resuscitative efforts outside the operating room. The anesthetist must identify and sort through a maze of conflicting courses of action, which must match the patient's desires and personal rights. The topic of DNR orders is addressed as well as some of the moral and ethical dilemmas they pose for the Certified Registered Nurse Anesthetist (CRNA). Some solutions are offered to help the nurse anesthetist make those decisions that are most "right" for the patient.
该国老年人口不断增长，使得处理“不要复苏”（DNR）医嘱的数量变得越来越困难。部分原因在于接受麻醉和手术的老年人数量增加。这也可归因于这些医嘱给包括麻醉师在内的护理DNR患者的医护人员带来的复杂法律、伦理和道德问题的增多。“DNR”一词让包括医护人员在内的许多人感到困惑。随着患者度过围手术期，由于麻醉管理包括插管、通气和液体补充等干预措施，这种困惑更加复杂。这些干预措施可能被视为手术室之外的复苏努力。麻醉师必须识别并梳理出一系列相互冲突的行动方案，这些方案必须符合患者的意愿和个人权利。本文讨论了DNR医嘱的话题以及它们给注册护士麻醉师（CRNA）带来的一些道德和伦理困境。还提供了一些解决方案，以帮助护士麻醉师做出对患者最“正确”的决定。
