Gastric point-of-care ultrasound (POCUS) has emerged as a valuable tool in anesthesia, offering significant benefits in assessing gastric content and volume, thereby improving patient safety. This imaging modality is particularly useful in assessing the risk of aspiration, which is a major concern during anesthesia, especially in emergency situations where the patient’s fasting status is unknown (1). By providing real-time visualization of the stomach, gastric POCUS assists the anesthesiologist in making informed decisions regarding airway management and the need for rapid sequence induction (RSI).
Gastric POCUS scans the patient’s stomach to detect the presence of solid, liquid, or gaseous contents. This technique uses a low frequency curvilinear or phased array transducer, typically positioned in the epigastric region or left upper quadrant of the abdomen. Assessment is performed in both the supine and right lateral decubitus positions to optimize visualization. Studies have shown that gastric POCUS is highly sensitive and specific in identifying gastric contents, with accuracy rates comparable to computed tomography (CT) and magnetic resonance imaging (MRI) (2).
One of the most important applications of gastric POCUS in anesthesia is the assessment of gastric emptying. Understanding the volume and type of gastric contents is critical in determining the risk of pulmonary aspiration. A stomach filled with solid food or significant amounts of fluid increases aspiration risk. Awareness of such a situation allows the anesthesiologist to take valuable precautions such as fasting, use of prokinetic agents, or modification of the anesthetic plan. Gastric POCUS provides a direct assessment of gastric volume, allowing for better risk stratification for patients requiring anesthesia (3). This is particularly important in scenarios involving obstetric anesthesia, trauma patients, or individuals with delayed gastric emptying due to conditions such as diabetes mellitus.
In addition to preoperative assessment, this technique can be used intraoperatively and postoperatively. During surgery, gastric POCUS can help manage patients with unexpectedly full stomachs, guiding the administration of anesthesia and potentially preventing aspiration events. In the postoperative period, gastric POCUS can monitor the return of gastric motility, which is important in determining readiness for oral intake and discharge from the recovery unit (2).
The incorporation of gastric POCUS into clinical practice requires appropriate training and experience. Anesthesiologists must develop proficiency in performing and interpreting gastric ultrasound to ensure accurate assessments. Educational programs and hands-on workshops have been shown to significantly improve the skills necessary to effectively use this tool (1). Moreover, the development of standardized protocols and guidelines for gastric POCUS in anesthesia will facilitate its widespread adoption and ensure consistency in its application.
Ongoing research and technological advances are expected to improve the utility and accuracy of gastric POCUS. Innovations such as automated image analysis and integration with other imaging modalities may further enhance its diagnostic capabilities. In addition, the growing evidence base supporting its use in various clinical scenarios is likely to drive more widespread adoption in anesthesia practice (3).
In conclusion, gastric POCUS represents a significant advancement in the field of anesthesia, offering a non-invasive, rapid, and reliable method for assessing gastric content and volume. Its application enhances patient safety by aiding in the identification of aspiration risks and guiding appropriate anesthetic management. Continued emphasis on training and research will further integrate this technique into routine clinical practice, ultimately improving outcomes in anesthesia care.
References
- Bouvet L, Mazoit JX, Chassard D, Allaouchiche B, Boselli E, Benhamou D. Clinical assessment of the ultrasonographic measurement of the antral area for estimating preoperative gastric content and volume. Anesthesiology. 2011;114(5):1086-1092. doi:10.1097/ALN.0b013e31820dee48
- Van de Putte P, Perlas A. Ultrasound assessment of gastric content and volume. Br J Anaesth. 2014;113(1):12-22. doi:10.1093/bja/aeu151
- Perlas A, Chan VW, Lupu CM, Mitsakakis N, Hanbidge A. Ultrasound assessment of gastric content and volume. Anesthesiology. 2009;111(1):82-89.
