Features  |   March 2014
Perioperative Do-Not-Resuscitate Orders
Author Affiliations
  • Richard J. Kelly, M.D., J.D., M.P.H., FCLM
    Committee on Ethics
Article Information
Critical Care / Palliative Care / End-of-Life Care / Features
Features   |   March 2014
Perioperative Do-Not-Resuscitate Orders
ASA Monitor 03 2014, Vol.78, 14-47.
ASA Monitor 03 2014, Vol.78, 14-47.
Vex not his ghost. O, let him pass. He hates him that would upon the rack of this tough world stretch him out longer.
– The Earl of Kent comments on the king’s death in The Tragedy of King Lear
An 83-year-old man with metastatic prostate cancer develops a small bowel obstruction. He has an active DNR order but consents to the surgery with no further discussion about his DNR status. Shortly after being brought to the operating room and undergoing general anesthesia, he develops ventricular tachycardia. Chest compressions are started and after multiple epinephrine boluses and asynchronous cardioversion, the patient regains a perfusing sinus rhythm. The anesthesiologist starts an epinephrine infusion while the surgeon leaves to consult with the patient’s family who, wanting to honor the patient’s wishes expressed in his DNR order, requests the epinephrine infusion be discontinued with no further attempts at resuscitation. The anesthesiologist agrees and, after the epinephrine infusion has been stopped, the patient’s blood pressure declines and the cardiac rhythm again degenerates to ventricular tachycardia. This time no CPR is performed and the patient expires in the operating room.
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