Perioperative pulmonary aspiration of gastric content is a serious complication. Fasting guidelines try to ensure an empty stomach before intervention. Certain medications or pathologies may cause delayed gastric emptying. Bedside ultrasonography is a useful tool when gastric content status is unclear or in emergency situations where fasting is not feasible. The aim of this prospective case-control observational study was to assess differences in gastric fluid volume between fasted patients with or without predisposing factors for delayed gastric emptying. Patients were preoperatively scanned. Antral cross-sectional area was measured by two tracing methods and total gastric clear fluid volumes were calculated. Data was recorded from September 2018 to March 2019 in a university hospital setting in Barcelona, Spain. Fifty-three patients were enrolled, 23 with delayed gastric emptying predisposing factors (DGEF) and 30 without non-DGEF. Ultrasound-estimated gastric clear fluid volume was 35.21 ± 32.69 mL in the DGEF versus 53.50 ± 30.72 mL in the non-DGEF group (p = 0.08). Average volume per unit of weight was 0.61 ± 0.46 mL/kg. Only 1 patient in the DGEF group had a volume that posed a higher risk of aspiration (1.57 mL/kg). Perfect correlation (R = 0.91; p < 0.01) and concordance (0.91; 95% CI 0.83; 0.95) was found between tracing methods. Minimal gastric content was observed in scheduled surgery in spite of predisposing factors for delayed gastric emptying. Ultrasound clear gastric volume estimation was useful to assess preoperative bedside gastric content.

A 79-year-old ASA class 3 patient scheduled for outpatient testing secondary to prostate cancer, was found to have a previously unknown 10-cm abdominal aortic aneurysm (AAA) causing acute renal insufficiency and hydronephrosis, requiring prompt surgical intervention. The patient was instructed to return to the hospital for further evaluation of the AAA and emergent ureteral stent placement. During the preanesthetic examination, the patient revealed he had eaten a small amount of food before returning to the hospital, placing him at increased risk of pulmonary aspiration. Traditional fasting times would have warranted either a delay in starting the case or performing it under general anesthesia with an endotracheal tube, both at increased risk to the patient. Instead, a point-of-care ultrasound gastric study was performed at the bedside to assess for gastric contents, which revealed the stomach was empty. The case proceeded under monitored anesthesia care without incident. A metallic stent was successfully employed, correcting the hydronephrosis and allowing for further evaluation and treatment of the AAA.