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Anesthesia

Gastric Point-of-Care Ultrasound (POCUS)

Gastric point-of-care ultrasonography is a bedside diagnostic examination used to evaluate gastric contents before anesthesia induction and support individualized aspiration risk assessment. This activity reviews gastric anatomy, scanning techniques, interpretation of qualitative findings, and quantitative assessment of gastric volume in patients with uncertain fasting status or conditions associated with delayed gastric emptying. The existing practice gap is that clinicians may inconsistently i

v1 · Reviewed Nov 8, 2026 by Automated Clinical Reviewer (Strict Verbatim v1)
  • Aspiration of gastric contents occurs in approximately 1 in every 900 surgical procedures using general anesthesia and accounts for significant perioperative morbidity and an inpatient mortality incidence of 20%.
  • Aspiration can lead to hypoxia, bronchospasm, pneumonitis, pneumonia, acute respiratory distress syndrome, and death.
  • Food or liquids in the stomach before anesthesia induction are among the greatest risk factors for perioperative pulmonary aspiration.
  • Uncertain fasting status
  • Patients at increased risk of delayed gastric emptying or pulmonary aspiration include those with the following conditions:
  • Gastric point-of-care ultrasonography is a bedside diagnostic examination used to evaluate gastric contents before anesthesia induction and support individualized aspiration risk assessment.
  • This examination allows anesthesia clinicians to differentiate between a full and an empty stomach, determine the consistency of gastric contents (solids, thick liquids, clear liquids), and estimate the volume of gastric fluid
  • Gastric POCUS is performed in the parasagittal imaging plane
  • The stomach should be examined to observe the characteristics of any gastric contents, noting the presence of solids, thick liquids, or clear fluids.
  • Solids : Solids have a heterogeneous, frosted glass appearance on ultrasonography.
  • Thick liquids : Thick liquids (eg, yogurt) appear hyperechoic and homogeneous on gastric ultrasonography.
  • Clear liquids : Clear fluids appear hypoechoic (black) and homogeneous.
  • Empty : The empty stomach has a bulls-eye appearance, with a small or collapsed antrum surrounded by the sonographically distinct layers of the stomach wall.
gastric volume-to-body weight ratio
A gastric volume-to-body weight ratio of 1.5 mL/kg or less is considered normal, consistent with baseline secretions, and associated with a low risk of aspiration under anesthesia. A ratio greater than 1.5 mL/kg predicts a high risk of aspiration.
  • For elective procedures, cases should be canceled or postponed if the stomach contains solids, thick liquids, or a volume of clear fluids exceeding 1.5 mL/kg.
  • In emergency procedures or when gastric emptying is unpredictable or may not improve over time (eg, gastroparesis), the risk of aspiration and the optimal timing of the case should be discussed with the patient and proceduralist.
  • The anesthetic plan should include full aspiration precautions if the case must proceed.
  • Options include reduced or no sedation to preserve airway-protective reflexes, or, if sedation is required, ideally, airway protection with a rapid-sequence induction and endotracheal intubation.
  • Depending on the circumstances, the stomach can be decompressed with a nasogastric or orogastric tube either before induction of anesthesia or following intubation.
  • Absolute contraindications to gastric POCUS have not been identified.
  • Relative contraindications include abdominal wounds and epigastric bandages.
  • Patients who cannot be safely positioned in the right lateral decubitus position should not undergo gastric POCUS.
  • Aspiration can lead to hypoxia, bronchospasm, pneumonitis, pneumonia, acute respiratory distress syndrome, and death.
  • aspiration pneumonia among surgical patients is associated with a 4-fold increased risk of intensive care unit admission, a 9-day increase in length of stay, and a 7.6-fold increased risk of in-hospital mortality.
  • review
    Gastric Point-of-Care Ultrasound (POCUS). StatPearls [Internet] — David N. Flynn, Eric Goosenberg, Jay W. Schoenherr — StatPearls Publishing, 2026

Decision support only. Verify against local protocols and current labeling. Source: www.ncbi.nlm.nih.gov