Regional anesthesia and pain medicineApr 18, 2025

Guidelines for Using Stomach Ultrasound to Check Aspiration Risk in Complex Patients Having Regional Anesthesia and Pain Treatments

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗

Updated Jan 20, 2026

Abstract

Gastric point-of-care ultrasound (POCUS) may offer clinical value in assessing aspiration risk among medically complex patients undergoing procedures.

Medically complex populations may have differing gastric emptying and aspiration risk compared to healthy individuals.
Findings support the use of gastric POCUS in patients in active labor, those undergoing urgent cesarean sections, and those with diabetes.
Conditional support is given for using gastric POCUS in patients who are obese, receiving emergency care, enterally fed, or taking GLP-1 receptor agonists.
Routine use of gastric POCUS is not recommended in non-laboring pregnancies, elective cesarean delivery, or patients with gastroesophageal reflux disease (GERD).
Implementation of gastric POCUS may be limited by practical and training constraints, necessitating individualized decision-making.

Simplified

Gastric point-of-care ultrasound (POCUS) may offer clinical value in assessing aspiration risk among medically complex patients undergoing regional anesthesia and pain procedures. While the American Society of Anesthesiologists (ASA) preoperative fasting guidelines primarily apply to healthy individuals, medically complex populations often present with differing gastric emptying and aspiration risk. This narrative review, conducted by the American Society of Regional Anesthesia and Pain Medicine (ASRA-PM), adhered to PRISMA guidelines and was registered with PROSPERO. It focused on seven medically complex patient groups: those who are pregnant, obese, diabetic, have gastroesophageal reflux disease (GERD), are receiving emergency care, are enterally fed, or are taking GLP-1 receptor agonists (GLP-1RA). Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Practice recommendations were developed using an iterative expert consensus process, with final recommendations based on evidence strength, clinical relevance, and expert agreement. Findings support the use of gastric POCUS in patients in active labor, those undergoing urgent cesarean sections, and those with diabetes. Conditional support is given for obesity, emergency care, enteral feeding, and GLP-1RA use. Routine use is not recommended in non-laboring pregnancies, elective cesarean delivery, or GERD. While gastric POCUS may aid with aspiration risk evaluation, its use should complement clinical judgment. Implementation may be limited by practical and training constraints, requiring individualized decision-making. These recommendations serve as a foundation for future research and potential clinical guideline development. PROSPERO registration number: CRD42023445927.

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Guidelines for Using Stomach Ultrasound to Check Aspiration Risk in Complex Patients Having Regional Anesthesia and Pain Treatments

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