ASRA pain medicine narrative review and expert practice recommendations for gastric point-of-care ultrasound to assess aspiration risk in medically complex patients undergoing regional anesthesia and pain procedures

Authors

Stephen C. Haskins, Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA haskinss@hss.edu.
Yuriy S. Bronshteyn, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA.
Leila Ledbetter, Duke University Medical Center Library and Archives, Durham, North Carolina, USA.
Cristian Arzola, Anesthesia and Pain Management, Mount Sinai Hospital, Toronto, Ontario, Canada.
Hari Kalagara, Department of Anesthesiology, Mayo Clinic Jacksonville Campus, Jacksonville, Florida, USA.
David Hardman, Anesthesiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA.
Oliver Panzer, Department of Anesthesiology Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.
Marissa M. Weber, Department of Anesthesiology, Weill Cornell Medical College, New York, New York, USA.
Eric R. Heinz, Anesthesiology, The George Washington University, Washington, District of Columbia, USA.
Jan Boublik, Anesthesiology, Stanford Hospital and Clinics, Stanford, California, USA.
Javier Cubillos, Western University, London, UK.
Nadia Hernandez, Anesthesiology, University of Texas Health Science Center at Houston, Houston, Texas, USA.
Joshua Zimmerman, Department of Anesthesiology, University of Utah Health, Salt Lake City, Utah, USA.
Anahi Perlas, Anesthesia and Pain Management, Toronto Western Hospital, Toronto, Ontario, Canada.

Document Type

Journal Article

Publication Date

4-18-2025

Journal

Regional anesthesia and pain medicine

DOI

10.1136/rapm-2024-106346

Keywords

acute pain; chronic pain; ultrasonography

Abstract

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.

APA Citation

Haskins, Stephen C.; Bronshteyn, Yuriy S.; Ledbetter, Leila; Arzola, Cristian; Kalagara, Hari; Hardman, David; Panzer, Oliver; Weber, Marissa M.; Heinz, Eric R.; Boublik, Jan; Cubillos, Javier; Hernandez, Nadia; Zimmerman, Joshua; and Perlas, Anahi, "ASRA pain medicine narrative review and expert practice recommendations for gastric point-of-care ultrasound to assess aspiration risk in medically complex patients undergoing regional anesthesia and pain procedures" (2025). GW Authored Works. Paper 7029.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/7029

Department

Anesthesiology and Critical Care Medicine