Case

[fakin' the funk]

I think the important thing re: DNR in the OR is to respect the intent or principle of the DNR.

Usually, DNR indicates a choice by the patient or patient's advocate to avoid pain and suffering at the end of life when life is ending on the "expected" course of the patient's condition or terminal illness. Granny has a stroke, eventually is going to get aspiration PNA, get septic, and die.

I think most of us would agree that the things you're expected to need to do for the OP's case (GETA, intubation, pressors/inotropes, invasive lines, possible postop ventilation) are consistent with the principle of avoiding unnecessary pain and suffering at the end of life in this patient. This sounds like a family who would want everything done except CPR to their loved one. The goals of care could be a little more clear (like, a LOT more clear) but as anesthesiologist I personally wouldn't have a problem doing all interventions up to, but excluding, chest compressions in the OP's DNR patient.

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[madhi]

I invite your input and suggestions on a case . It was interesting episode. It was an argument which ensued between CRNA and an attending in the hospital. The argument was about , how CRNA want to proceed with application of lidocaine paste 2%-4% on the cuff of ET tube. His argument was based on the article in AANA , that application of 2-4% lidocaine paste improved the extubation times. The anesthesia attending was against it , his ground was that the chances of aspiration post operatively will be high , as lidocaine paste will numb the trachea. CRNA claimed that aspiration risk is not much as , he is going to apply it on cuff and as it a paste and it will anesthetize only smaller subglottic region. He went ahead did the case anyhow with lidocaine paste not jelly.

Attending tried to talk him with his suggestion, that it should done only on specific asthmatic cases or non obese elective patients with no GERD.

Your suggestions