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The Role of Anesthesiologists in Perioperative Limitation of Potentially Life-Sustaining Medical Treatments: A Narrative Review and Perspective.

Publication ,  Journal Article
Cushman, T; Waisel, DB; Treggiari, MM
Published in: Anesth Analg
September 1, 2021

No patient arrives at the hospital to undergo general anesthesia for its own sake. Anesthesiology is a symbiont specialty, with the primary mission of preventing physical and psychological pain, easing anxiety, and shepherding physiologic homeostasis so that other care may safely progress. For most elective surgeries, the patient-anesthesiologist relationship begins shortly before and ends after the immediate perioperative period. While this may tempt anesthesiologists to defer goals of care discussions to our surgical or primary care colleagues, we have both an ethical and a practical imperative to share this responsibility. Since the early 1990s, the American College of Surgeons (ACS), the American Society of Anesthesiologists (ASA), and the Association of Perioperative Registered Nurses (AORN) have mandated a "required reconsideration" of do-not-resuscitate (DNR) orders. Key ethical considerations and guiding principles informing this "required reconsideration" have been extensively discussed in the literature and include respect for patient autonomy, beneficence, and nonmaleficence. In this article, we address how well these principles and guidelines are translated into daily clinical practice and how often anesthesiologists actually discuss goals of care or potential limitations to life-sustaining medical treatments (LSMTs) before administering anesthesia or sedation. Having done so, we review how often providers implement goal-concordant care, that is, care that reflects and adheres to the stated patient wishes. We conclude with describing several key gaps in the literature on goal-concordance of perioperative care for patients with limitations on LSMT and summarize novel strategies and promising efforts described in recent literature to improve goal-concordance of perioperative care.

Duke Scholars

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Published In

Anesth Analg

DOI

EISSN

1526-7598

Publication Date

September 1, 2021

Volume

133

Issue

3

Start / End Page

663 / 675

Location

United States

Related Subject Headings

  • Resuscitation Orders
  • Professional Role
  • Practice Guidelines as Topic
  • Perioperative Care
  • Humans
  • Health Knowledge, Attitudes, Practice
  • Guideline Adherence
  • Attitude of Health Personnel
  • Anesthesiology
  • Anesthesiologists
 

Citation

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ICMJE
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Cushman, T., Waisel, D. B., & Treggiari, M. M. (2021). The Role of Anesthesiologists in Perioperative Limitation of Potentially Life-Sustaining Medical Treatments: A Narrative Review and Perspective. Anesth Analg, 133(3), 663–675. https://doi.org/10.1213/ANE.0000000000005559
Cushman, Tera, David B. Waisel, and Miriam M. Treggiari. “The Role of Anesthesiologists in Perioperative Limitation of Potentially Life-Sustaining Medical Treatments: A Narrative Review and Perspective.Anesth Analg 133, no. 3 (September 1, 2021): 663–75. https://doi.org/10.1213/ANE.0000000000005559.
Cushman, Tera, et al. “The Role of Anesthesiologists in Perioperative Limitation of Potentially Life-Sustaining Medical Treatments: A Narrative Review and Perspective.Anesth Analg, vol. 133, no. 3, Sept. 2021, pp. 663–75. Pubmed, doi:10.1213/ANE.0000000000005559.

Published In

Anesth Analg

DOI

EISSN

1526-7598

Publication Date

September 1, 2021

Volume

133

Issue

3

Start / End Page

663 / 675

Location

United States

Related Subject Headings

  • Resuscitation Orders
  • Professional Role
  • Practice Guidelines as Topic
  • Perioperative Care
  • Humans
  • Health Knowledge, Attitudes, Practice
  • Guideline Adherence
  • Attitude of Health Personnel
  • Anesthesiology
  • Anesthesiologists