单项选择题
Mr. S is a 73-year-old man, with a history of severe coronary artery
disease, peripheral vascular disease, and stroke. He suffers from
right hemiplegia and mild expressive aphasia. He is awake and alert,
and presents for right below the knee amputation (BKA) for vascular
insufficiency. His chart carries a DNR order. In the holding area prior
to surgery, the anesthesiologist discusses the DNR order with Mr. S,
who appears depressed. Mr. S states unequivocally, that he does not
wish CPR in the OR, regardless of its cause or positive prognosis.
He tells his anesthesiologist that he is willing to go "so far, and no
more." The patient agrees to subarachnoid anesthesia (spinal block)
and sedation. He is not intubated. After about 20 minutes, the patient
complains of weakness in his arms, and difficulty breathing. Within 3
minutes, his blood pressure and heart rate fall, and he abruptly
arrests.
Should the patient be intubated and CPR commenced?
A．Yes, because the probable cause of Mr. S's arrest is a
cephalad migration of local anesthetic in the subarachnoid
space, leading to a "high spinal block." With cardiopulmonary
support, the prognosis for total recovery from this event is
excellent.
B． No, because intubation, mechanical ventilation and CPR would
be senseless due to medical futility in this case.
C．No, because the patient stated clearly his wishes to not be
resuscitated if an arrest occurs.
D． Yes, because the Anesthesiologist is under a duty to treat the
apparent anesthesia complication.
