Illustrated ultrasound evaluation of the stomach fasting/nonfasting status

Document Type

Book Chapter

Publication Date

1-1-2025

Publication Title

Pharmacology Physiology and Practice in Obstetric Anesthesia

Abstract

Perioperative pulmonary aspiration is a feared complication of anesthesia especially in pregnancy, associated with potentially fatal lung injuries such as pneumonitis, pneumonia, and acute respiratory distress syndrome. Although pulmonary aspiration is rare, affecting 1 in every 2000-3000 patients undergoing general anesthesia, the incidence accounts for over 50% of airway-related deaths in anesthesia. The presence of gastric contents prior to induction of anesthesia greatly amplifies the risk of perioperative pulmonary aspiration. This chapter focuses on the use of ultrasound to assess gastric volume and contents for perioperative aspiration management and improvement in anesthesia safety. Although fasting guidelines implemented by the American Society of Anesthesiologists allow time for gastric emptying, patients with obscure NPO status or comorbidities such as pregnancy, placing them at risk of a higher gastric volume may benefit from additional testing and standards. At present, gastric ultrasound is a simple, noninvasive, diagnostic tool shown to be effective in assessing the qualitative nature of gastric content and quantitative calculation of gastric volume. Information from gastric ultrasound aids anesthesia providers in optimizing timing, induction, and airway management techniques. Nevertheless, with limitations involving sonographer training, accurate analysis of gastric contents, and standardization of protocols, the widespread adoption of the practice is lagging.

First Page

683

Last Page

692

ISBN

[9780443217067, 9780443217074]

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