INTRODUCTION & INDICATIONS

Introduction

 

This website contains information on the following skills: 

  • Performing a standardized gastric ultrasound exam
  • Identifying the sonographic features of an empty stomach versus one with clear fluid or thick fluid/solid content
  • Measuring gastric fluid volume 
  • Interpreting the findings of gastric sonography and its implications for aspiration risk assessment

 

The content of this website is updated regularly and believed to represent current state of knowledge but is provided as reference only. Any clinical decision regarding aspiration prophylaxis has to include a thorough patient assessment and consideration of the multiple factors that influence aspiration risk in addition to gastric content. Gastric ultrasound findings may be inaccurate in subjects with abnormal underlying gastric anatomy (e.g. previous gastric resection or bypass, gastric band in situ, previous fundoplication, large hiatus hernia).

Perioperative aspiration of gastric contents is a serious complication of anesthesia associated with high morbidity and mortality. Preoperative fasting guidelines help limit the risk in elective patients with minimal co-morbidities. However, fasting intervals are not applicable or reliable in urgent or emergency surgeries or for patients with certain medical conditions. Gastric ultrasound is a point-of-care tool for aspiration risk assessment. It can determine the nature of the content (empty, clear fluid, thick fluid / solid) and when clear fluid is present, its volume can be estimated. 


INDICATIONS

Any clinical situation where gastric content is uncertain. For example:

 

Lack of adherence to fasting instructions:

  • Emergency/urgent procedure
  • “Miscommunication”

Unreliable/unclear fasting history:

  • Altered sensorium
  • Language barrier
  • Cognitive dysfunction
  • Inconsistent history
  • Pediatrics
Potential delay in gastric emptying:
  • Pregnancy/labour
  • Diabetes
  • Severe liver or kidney dysfunction
  • Neuromuscular disorders
  • Critical illness
  • Severe obesity

WHO WE ARE

EDITORS

Peter Van de Putte, MD PhD
Peter Van de Putte, MD PhD
Anesthesiologist • Imelda Hospital • Bonheiden, Belgium

Peter Van de Putte studied medicine at the Catholic University of Leuven, Belgium where he obtained his degree in 1991. He received his specialty qualification in anaesthesiology in 1996. From 1996 until 2019, he was staff member of the Department of Anesthesiology at the Hospital AZ Monica, Antwerp, Belgium. He currently is staff member of the department of anaesthesiology at the Imelda Hospital in Bonheiden, Belgium.

His interests are loco-regional anesthesia, point-of-care ultrasound and resident teaching. Most of his current research involves point-of-care gastric ultrasound (gastric PoCUS) and its development as an application for assessment of aspiration risk in perioperative patients. He has given many lectures and workshops and published extensively on this theme. It is also the topic of the PhD he defended on May 1st, 2019 at the Radboud University, the Netherlands (PhD title “Point-of-care gastric ultrasound: an aspiration risk assessment tool”).

Anahi Perlas, MD
Anahi Perlas, MD
Anesthesiologist • Toronto Western Hospital • Toronto, Canada

Dr. Perlas is Professor of Anesthesia at the University of Toronto and Director of the Clinical Regional Anesthesia Program at the Toronto Western Hospital in Ontario, Canada. Her research focuses on perioperative applications of ultrasound for diagnostic (gastric ultrasound) and interventional (regional anesthesia) uses. She has published over 70 peer-reviewed original articles in the areas of PoCUS (point-of-care ultrasound) and regional anesthesia.  Dr. Perlas is Executive Editor of the journal Regional Anesthesia and Pain Medicine.  She has several leadership roles in the area of PoCUS in North America.  She is a current member of the American Society of Anesthesiologists’ Editorial board on PoCUS where she is the lead editor for Gastric Ultrasound. She is a founding member of the Special Interest Group on PoCUS of the American Society of Regional Anesthesia and Pain Medicine and a co-author of the 1st Canadian Consensus Conference on guidelines for perioperative PoCUS applications. 

Lionel Bouvet, MD PhD
Lionel Bouvet, MD PhD
Anesthesiologist • Hospital Civils de Lyon • Lyon, France

Lionel Bouvet is a member of the department of anesthesia and critical care medicine in obstetrics and pediatric surgery, at the Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France. He is particularly involved in the organization of the operating theaters and in the development of day case surgery activity and fast track in obstetrics. Lionel Bouvet has published several research articles focusing on assessment and prevention of the risk of pulmonary aspiration of gastric contents in anesthesia and critical care medicine, and more particularly on gastric ultrasound.  His teaching interests are obstetric anesthesia and point-of-care ultrasound. He is member of the Board of Directors of the French group of Anesthesia and Critical Care Medicine in Obstetrics (CARO, Club d’Anesthésie et Réanimation en Obstétrique) and of the scientific committee of the AZUREA research network. He is also member of the French Society of Anesthesia and Intensive Care (SFAR, Société Française d’Anesthésie et de Réanimation) and of the European Society of Anaesthesiology.

collaborators

Cristian Arzola, MD
Cristian Arzola, MD
Anesthesiologist • Mount Sinai Hospital • Toronto, Canada

Dr. Cristian Arzola is an Associate Professor of Anesthesiology at the University of Toronto and staff anesthesiologist at Mount Sinai Hospital in Toronto, Ontario, Canada. His training includes a master degree in Clinical Epidemiology, Applied Biostatistics, Medical Education and a Fellowship in Obstetric Anesthesia. His research and teaching interests are obstetric anesthesia, ultrasound-assisted neuraxial blocks and point-of-care ultrasound applications in obstetric anesthesia.

Jeff Gadsden, MD
Jeff Gadsden, MD
Professor of Anesthesiology • Duke University • Buffalo, USA

Jeff Gadsden is a Professor of Anesthesiology at Duke University, and Chief of the Division of Orthopedic, Plastic and Regional Anesthesiology. He graduated with an M.D. in 1999 from Queen’s University, Canada, and undertook training in anesthesiology at the University of Toronto and St. Luke’s-Roosevelt Hospital in New York City.  His research and clinical interests include ultrasound-guided nerve blockade, point-of-care ultrasound, and trauma care, but mostly what he enjoys is teaching. 

Richelle Kruisselbrink, MD
Richelle Kruisselbrink, MD
Anesthesiologist • Grand River Hospital • Kitchener, Canada

Richelle Kruisselbrink is an Assistant Professor and member of the Department of Anesthesiology at McMaster University. She completed a fellowship in ultrasound-guided regional anesthesia at the University of Toronto and is a Testamur of the National Board of Echocardiography, having successfully completed the Examination of Special Competence in Adult Echocardiography. Her clinical and research interests include the perioperative applications of point-of-care ultrasound. She is active in education locally, provincially and internationally and was the recipient of the New Faculty Teaching Excellence award at the University of Toronto in 2016.  

Adam Spencer, MD
Adam Spencer, MD
Anesthesiologist • Alberta Children's Hospital • Calgary, Canada

Adam is a Pediatric Anesthesiologist and Pain Physician at the Alberta Children's Hospital and Adult Anesthesiologist at the South Health Campus in Calgary, Alberta, Canada. He is a Clinical Associate Professor at the University of Calgary’s Cumming School of Medicine. His research interests focus on procedural and diagnostic ultrasound techniques, regional anesthesia and pain medicine. He has spearheaded a number of perioperative guidelines to help improve care for pediatric patients undergoing painful procedures and has developed the Alberta Children’s Hospital’s ambulatory continuous peripheral nerve block program. He has multiple publications related to perioperative ultrasound, regional anesthesia and pain medicine. He also teaches regional anesthesia and PoCUS workshops at a local and international level.

collaborators

Cristian Arzola, MD
Cristian Arzola, MD
Anesthesiologist • Mount Sinai Hospital • Toronto, Canada

Dr. Cristian Arzola is an Associate Professor of Anesthesiology at the University of Toronto and staff anesthesiologist at Mount Sinai Hospital in Toronto, Ontario, Canada. His training includes a master degree in Clinical Epidemiology, Applied Biostatistics, Medical Education and a Fellowship in Obstetric Anesthesia. His research and teaching interests are obstetric anesthesia, ultrasound-assisted neuraxial blocks and point-of-care ultrasound applications in obstetric anesthesia.

Jeff Gadsen, MD
Jeff Gadsen, MD
Professor of Anesthesiology • Duke University • Buffalo, USA

Jeff Gadsden is a Professor of Anesthesiology at Duke University, and Chief of the Division of Orthopedic, Plastic and Regional Anesthesiology. He graduated with an M.D. in 1999 from Queen’s University, Canada, and undertook training in anesthesiology at the University of Toronto and St. Luke’s-Roosevelt Hospital in New York City.  His research and clinical interests include ultrasound-guided nerve blockade, point-of-care ultrasound, and trauma care, but mostly what he enjoys is teaching. 

Richelle Kruisselbrink, MD
Richelle Kruisselbrink, MD
Anesthesiologist • Grand River Hospital • Kitchener, Canada

Richelle Kruisselbrink is an Assistant Professor and member of the Department of Anesthesiology at McMaster University. She completed a fellowship in ultrasound-guided regional anesthesia at the University of Toronto and is a Testamur of the National Board of Echocardiography, having successfully completed the Examination of Special Competence in Adult Echocardiography. Her clinical and research interests include the perioperative applications of point-of-care ultrasound. She is active in education locally, provincially and internationally and was the recipient of the New Faculty Teaching Excellence award at the University of Toronto in 2016.  

Adam Spencer, MD
Adam Spencer, MD
Anesthesiologist • Alberta Children's Hospital • Calgary, Canada

Adam is a Pediatric Anesthesiologist and Pain Physician at the Alberta Children's Hospital and Adult Anesthesiologist at the South Health Campus in Calgary, Alberta, Canada. He is a Clinical Associate Professor at the University of Calgary’s Cumming School of Medicine. His research interests focus on procedural and diagnostic ultrasound techniques, regional anesthesia and pain medicine. He has spearheaded a number of perioperative guidelines to help improve care for pediatric patients undergoing painful procedures and has developed the Alberta Children’s Hospital’s ambulatory continuous peripheral nerve block program. He has multiple publications related to perioperative ultrasound, regional anesthesia and pain medicine. He also teaches regional anesthesia and PoCUS workshops at a local and international level.

Disclaimer

Gastricultrasound.org is a free web-based educational resource that contains information related to the performance and interpretation of point-of-care perioperative gastric ultrasound for aspiration risk assessment. The information provided is based on peer-reviewed data and the opinion of the editors. The editors and contributors cannot be held responsible for any clinical decisions taken as a result of information contained in this website.