DO NOT RESUSCITATE (DNR) ORDERS IN THE PERIOPERATIVE PERIOD - A COMPARISON OF THE PERSPECTIVES OF ANESTHESIOLOGISTS, INTERNISTS, AND SURGEONS

The purpose of this descriptive study is to compare and contrast the e xperience, perceptions, and opinions of practicing anesthesiologists, internists, and surgeons regarding ''do not resuscitate'' (DNR) orders in the perioperative period. A questionnaire was mailed to 600 intern ists and 600 surgeons. Responses from these two groups were analyzed a nd compared with the results of a previously reported survey of 420 an esthesiologists. One hundred ninety-two of 570 (34%) and 199/584 (34%) acknowledged responses were received from internists and surgeons, re spectively Anesthesiologists (114/190; 60%) were more likely than inte rnists (61/182; 34%) or surgeons (71/194; 37%) to assume DNR suspensio n in the perioperative period and were less likely than their colleagu es to discuss with the patient the implications of their DNR order dur ing anesthesia and surgery. This assumption of DNR suspension by anest hesiologists was underestimated by both surgeons and internists. Anest hesiologists and surgeons were more similar than internists in their m anner of utilization of resuscitative measures in the setting of a car diopulmonary arrest. All groups were more likely to require DNR suspen sion for elective than for palliative cases. The majority of all group s concurred that physician responsibility for defining DNR status in t he perioperative period should be shared by the anesthesiologist, surg eon, and primary care physician and not prescribed by hospital policy. The manner in which a DNR order is perceived in the perioperative per iod varies considerably among specialties and warrants further discuss ion among these groups.