PEDIATRICS Vol. 114 No. 6 December 2004, pp. 1686-1692 (doi:10.1542/peds.2004-2119)

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CLINICAL REPORT

Do-Not-Resuscitate Orders for Pediatric Patients Who Require Anesthesia and Surgery

This clinical report addresses the topic of preexisting do-not-resuscitate (DNR) orders for children undergoing anesthesia and surgery. Pertinent issues addressed include the rights of children, surrogate decision-making, the process of informed consent, and the roles of surgeons and anesthesiologists. The reevaluation process of DNR orders called "required reconsideration" can be incorporated into the process of informed consent for surgery and anesthesia. Care should be taken to distinguish between goal-directed and procedure-directed approaches to DNR orders. By giving parents or other surrogates and clinicians the option of deciding from among full resuscitation, limitations based on procedures, or limitations based on goals, the child's needs are individualized and better served.

Key Words: anesthesia • pediatric surgery • pediatrics • children • resuscitation • cardiac arrest • respiratory arrest

Abbreviations: DNR, do-not-resuscitate • CPR, cardiopulmonary resuscitation • ASA, American Society of Anesthesiologists • ACS, American College of Surgeons

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