Pediatric DNAR orders in the perioperative period

Area of Science:

• Medical Ethics
• Anesthesiology
• Pediatric Critical Care

Background:

• Do Not Attempt Resuscitation (DNAR) orders are widely accepted in hospitals but face challenges in the perioperative setting.
• Anesthesia can cause cardiovascular instability, and improved cardiac arrest outcomes complicate DNAR acceptance in operating rooms.
• The overlap between anesthetic techniques and resuscitation practices raises questions about DNAR order application during surgery.

Purpose of the Study:

• To investigate the opinions of pediatric anesthetists regarding Do Not Attempt Resuscitation (DNAR) orders in the perioperative period.
• To understand anesthetists' views on altering or suspending DNAR orders during anesthesia and surgery.
• To identify areas of consensus and disagreement concerning DNAR orders and resuscitation interventions in pediatric anesthesia.

Main Methods:

• A questionnaire was distributed to all consultant members of the Association of Paediatric Anaesthetists of Great Britain and Ireland.
• The survey included questions on DNAR orders, resuscitation under anesthesia, and presented case studies.
• Data from 280 respondents were analyzed to determine opinions and practices.

Main Results:

• 57.1% of respondents agreed that anesthetists could alter DNAR orders in the perioperative period.
• 14.6% of respondents indicated they would always suspend a DNAR order.
• Most anesthetists agreed to discuss DNAR orders preoperatively but disagreed on distinguishing anesthetic practice from resuscitation interventions.

Conclusions:

• There is significant variation in practice among pediatric anesthetists regarding the suspension of DNAR orders during the perioperative period.
• Current practices lack specific guidelines, leading to inconsistent application of DNAR orders.
• Development of clear guidelines for DNAR orders in pediatric perioperative care is recommended, considering existing work and international practices.