Pulmonary aspiration during anesthesia remains an uncommon but clinically significant perioperative complication associated with substantial morbidity and mortality. Although contemporary fasting guidelines recommend minimum fasting intervals to reduce aspiration risk, adherence does not guarantee an empty stomach, particularly in patients with delayed gastric emptying or those receiving medications that impair gastrointestinal motility, such as glucagon-like peptide-1 receptor agonist (GLP-1 RA)-based therapies. Preanesthetic gastric ultrasound has emerged as a practical point-of-care modality for the qualitative and quantitative assessment of gastric content and volume, enabling individualized aspiration risk stratification in selected patients. However, the current evidence base remains insufficient to formally support evidence-graded clinical practice guidelines. The consensus-based recommendations presented in this guideline were developed through expert discussion and review of the available literature, in which robust evidence is lacking. They provide practical guidance on the indications for preanesthetic gastric ultrasound, core examination principles and interpretation, integration of ultrasound findings into perioperative decision-making, management when gastric ultrasound is not feasible, and anesthetic strategies for patients with a full stomach. Special recommendations are included for patients receiving GLP-1 RA-based therapies, emphasizing the continuation of these medications in most patients with individualized risk assessment, consideration of a 24-h clear liquid diet, and the use of gastric ultrasound when delayed gastric emptying is suspected. Preanesthetic gastric ultrasound provides a practical bedside method for assessing gastric content and estimating aspiration risk in patients undergoing anesthesia. These recommendations are intended to support, not replace, clinical judgment and should be refined through future prospective outcome-based studies.
