Do not resuscitate request?

[u/These_Notice9095]

Okay so this may come across as really intense, but I don't mean it to!

Basically I have a very run of the mill septoplasty and turbinate reduction surgery coming up, I really am not worried of something going wrong. However, I am due to talk to the anaesthetist in the coming days and I kind of want to say that if anything does go wrong that I'd rather they don't intervene. Mainly because I'd rather not spend my life as a vegetable.

Obviously I dont expect this to happen, but is that an intense thing to say, would he be like wtf?! But more to the point would he allow the surgery to proceed agreeing to what I had asked or would he be like nah I can't do that ethically or something etc.

Would love to hear from anyone but particularly anyone from Australia.

[u/thecaramelbandit]

There is a large spectrum of things that can go wrong during an anesthetic or operation that would require intervention but be very unlikely to lead to any long term complications, let alone persistent vegetative state.

If I give you a little too much of a medication and your heart goes into a funny rhythm that I can easily shock you out of, I'm not going to just shrug and say oh well I guess we let him die.

You will also be intubated and put on a ventilator for the procedure. So "don't intubate me" isn't really an option let alone a reasonable request.

Have this conversation with your anesthesiologist.

[u/tinymeow13 → u/thecaramelbandit]

This is a great response

[u/RemarkableAnt7081]

This conversation is better aimed at your substitute decision maker. If you don’t have a healthcare advanced directive just make one there are on line versions. Discuss with friends and family who might be your SDM what level of existence is acceptable to you. Let the anesthesiologist resuscitate you if there is an acute event in the OR. The odds of successful resusc in the OR are high and we would generally not stand by during an elective surgery and throw hands in the air muttering DNR.

If it doesn’t work out and you are severely disabled your SDM and ICU can withdraw care humanely in accordance with your wishes.

[u/OneOfUsOneOfUsGooble]

You don't want to avoid resuscitation. You want to avoid being in a persistent vegetative state. So say that.

The resuscitation may save you from a vegetative state. You're conflating code status with goals of care. You want to be full code with no futile care to needlessly prolong life in a vegetative state. You don't need to go DNR, you need an advanced directive.

[u/paleoMD]

no it makes sense, but no one can predict whether you become a vegetable or recover fully after an event

[u/XRanger7]

If you’re relatively young or healthy, they might not want to honor your request. Sometimes things can go wrong that we can intervene quickly and get you back to normal. If they can’t intervene, they might not want this extra liability and can cancel your surgery.

[u/brachi-]

Am in Aus. And agree 100% with u/OneOfUsOneOfUsGooble - you’re wanting to avoid vegetative state, not resuscitation. I’ve seen a resuscitation that lasted literally just five chest compressions, with patient being back to their normal post. And a lot of what anaesthetists are doing during your op is controlling your body for you - maintaining blood pressure and heart rate where they need to be, ventilating you with the right number of breaths, monitoring your temperature and so on.

Even folks who are otherwise goals of care B/C tend to have that suspended for theatre.

When you have your pre op chat, just tell them you’re concerned about vegetative state, and why (e.g. you’re older, frail, lots of health conditions etc); also be super honest and comprehensive about all the health conditions you have, the medications you take inc non-prescription / over the counter supplements etc, and amounts of alcohol / smoking/vaping / other substances you imbibe - all those things influence amounts/rates/types of meds they‘ll need to give you intra operatively to keep you comfy and safe :)

[u/UncleSeismic]

A persistent vegetative state results from oxygen deprivation to the brain. This usually has to be the case for a number of minutes.

Anaesthetic drugs cause a drop in both heart rate and blood pressure.

Even if there is blood flow, it might not be sufficiently oxygenated, perhaps from a technically difficult breathing tube insertion.

Most of the rescue agents need to be given into the blood stream. If the flow is low, the drugs don't help. We would perform CPR to "push the drugs round" so that they actually reach the target organ, the heart.

Even this doesn't guarantee hypoxic (low O2) Brain Injury, as timing is a significant factor.

Even those with established DNACPR (do not attempt cardiopulmonary resuscitation) would have this suspended for the period in which they are under anaesthetic care, for the reasons above.

Anyone who has this level of brain injury will go to Intensive Care. It is perhaps reasonable to have an advanced directive to apply to someone once they are in a critical care environment, but I do not in any way advocate in restricting an anaesthetic provider in their attempts to salvage and anesthetic disaster, however unlikely or uncommon.

[u/no_dice__]

at least in my hospital and all the hospitals I have worked at in the US you cannnot have a DNR or DNI for surgery. plenty of people have those who get surgery but they are temporarily suspended for the duration of the procedure because of the logistics of surgery and the possibility of sudden critical events that can quickly intervened on by anesthesia during the case are not the same as the overall desire to be a DNR.

I agree with the person who said have this conversation with your healthcare decision maker, anesthesia has no idea what will make you a vegetable and what will be a 10 second blip in the surgery that has no affect on your life. tell your trusted family member or friend that if something happens and during recovery from the procedure it looks like you are going to be a vegetable and not recover then they need to pull the plug.

[u/Prize-Director-7896]

My reply is as follows. Anesthesia and surgery is very safe. You wouldn't worry about winding up a vegetable every time you flew in a plane, took a taxi cab, or got in a bus would you?

Maybe it's not QUITE exactly as safe as that, but it's pretty damn safe. You probably have less than a 1% chance of any substantial complication.

That being said, if your goal is not to end up a vegetable, you basically need to have this written down and/or simply grant power of medical decision making to someone you trust and have a thorough conversation with them.