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LCDR David Leivers, MC
USN Naval Hospital Department of Anesthesia San Diego, Calif

JAMA. 1991;266(6):795.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—The recent update of the cardiopulmonary resuscitation guidelines¹ and editorial comment² are welcome as further developments in this complicated and evolving area. However, many specific problems were not addressed. Truog³ reviewed the question of the status of DNR orders in patients undergoing surgery and anesthesia. For anesthesiologists, there are special and frequently conflicting aspects of providing care during palliative surgery. The following case highlights this dilemma:

A 54-year-old man with endstage amyotrophic lateral sclerosis presented for gastrostomy. He was fully alert but confined to a wheelchair. He lived at home with his caring wife. His profound weakness did not permit coordinated swallowing, and his decline was being accelerated by malnutrition. Respiratory reserve was negligible with PaO₂ of 56 mm Hg breathing air and PaCO₂ of 54 mm Hg. In a discussion prior to the procedure, the patient and his wife revealed an . . . [Full Text PDF of this Article]

Footnotes
Supported by the United States Navy, Clinical Investigation Program report No 84-16-1968-278.

The views expressed in this letter are those of the author and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the US government.

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