Gastric Ultrasound for the Regional Anesthesiologist and Pain Specialist

Abstract

This article in our series on point-of-care ultrasound (US) for the regional anesthesiologist and pain management specialist describes the emerging role of gastric ultrasonography. Although gastric US is a relatively new point-of-care US application in the perioperative setting, its relevance for the regional anesthesiologist and pain specialist is significant as our clinical practice often involves providing deep sedation without a secured airway. Given that pulmonary aspiration is a well-known cause of perioperative morbidity and mortality, the ability to evaluate for NPO (nil per os) status and risk stratify patients scheduled for anesthesia is a powerful skill set. Gastric US can provide valuable insight into the nature and volume of gastric content before performing a block with sedation or inducing anesthesia for an urgent or emergent procedure where NPO status is unknown. Patients with comorbidities that delay gastric emptying, such as diabetic gastroparesis, neuromuscular disorders, morbid obesity, and advanced hepatic or renal disease, may potentially benefit from additional assessment via gastric US before an elective procedure. Although gastric US should not replace strict adherence to current fasting guidelines or be used routinely in situations when clinical risk is clearly high or low, it can be a useful tool to guide clinical decision making when there is uncertainty about gastric contents.In this review, we will cover the relevant scanning technique and the desired views for gastric US. We provide a methodology for interpretation of findings and for guiding medical management for adult patients. We also summarize the current literature on specific patient populations including obstetrics, pediatrics, and severely obese subjects.

Gastric function in diabetic gastroparesis assessed by ultrasound and scintigraphy

“…Ultrasound of the antrum is an accepted method for evaluating gastric emptying, showing good correlation to radionuclide emptying rate estimates 12 . It is often used by anesthesiologists as a “Point of care” examination to assess preoperative gastric contents 13,14 . The association between proximal stomach size and gastric emptying is, however, insufficiently studied.…”

Qualitative and quantitative gastric ultrasound assessment in highly skilled regional anesthesiologists

“…First, since the two evaluated anesthesiologists are both regional anesthesiologists, our results may not be representative of general anesthesiologists or other subspecialist anesthesiologists. However, it is arguably regional anesthesiologists who often manage patients with insecure airway [ 23 ]. Second, owing to time constraint and logistical issues, the gastric volume measurement was compared against the actual ingested volume.…”

“…Since regional anesthesia is regarded as a subspecialty with a recognized high level of skill in ultrasonography [ 22 ], two highly skilled regional anesthesiologists were selected to participate in this study. Moreover, regional anesthesiologists often find themselves in a setting where they have to manage patients without a secure airway [ 23 ]. Gastric ultrasound could be a valuable addition to the cache of clinical skills among regional anesthesiologists.…”

Evaluation of a Point-of-Care Ultrasound (POCUS) training course for Regional Anesthesiologists – A Single Institution’s Experience

“…This particular outcome is a manifestation of trainees using these skills in ICUs under faculty supervision as well as a coverage model at HSS where anesthesiologists manage ICU patients overnight. Additionally, this study only evaluates FOCUS and LUS, while other skills such as Gastric Ultrasound 20 , airway US, and the focused Assessment with Sonography for Trauma (FAST) exam 21 are also relevant to regional anesthesiologists. Future studies should pool data from a variety of POCUS courses to further identify changes in practice as well as the clinical benefits following POCUS training.…”