New gastric ultrasound recommendations identify when POCUS may help assess aspiration risk

The American Society of Regional Anesthesia and Pain Medicine (ASRA-PM) has released new expert recommendations for using gastric point-of-care ultrasound (POCUS) in medically complex patients where aspiration risk is difficult to determine from fasting history alone. The recommendations address patients with pregnancy, obesity, diabetes, reflux disease, emergency presentations, enteral tube feeding, and those using GLP-1 receptor agonists. Pulmonary aspiration of gastric contents during anesthesia is an important concern, as conditions such as pregnancy, diabetes, and obesity can alter gastric emptying rates. Gastric POCUS allows clinicians to assess the gastric antrum and estimate whether the stomach is empty or contains clear fluid, thick fluid, or solid material. Recommendations vary by patient population: supported in active labor and diabetes, conditionally supported in obesity and GLP-1RA use, and not recommended for routine use in non-laboring pregnancy and reflux disease. Studies demonstrated that patients with diabetes had a full stomach in 48% of cases compared to 8% in patients without diabetes.