title: Point-of-care ultrasound defines gastric content and changes the anesthetic management of elective surgical patients who have not followed fasting instructions: a prospective case series.
abstract: OBJECTIVE
  Pulmonary aspiration of gastric contents is a major cause of anesthesia morbidity and mortality. Point-of-care gastric ultrasound provides information regarding the type and volume of gastric content. The hypothesis of this prospective cohort study was that the addition of point-of-care gastric ultrasound to standard patient assessment results in changes in anesthetic management in at least 30% of elective surgical patients who do not follow fasting instructions.
  
  
  METHODS
  Following Research Ethics Board approval and informed consent, elective surgical patients who did not follow fasting instructions were included in this prospective study. Documentation included the type of food ingested, the timing of the ingestion relative to the planned surgical time, and the treating anesthesiologist's management plan based on history alone. Next, an independent anesthesiologist not involved in the medical decision-making performed a focused gastric ultrasound examination. The results of the ultrasound exam were documented in a standardized fashion and made available to the attending anesthesiologist who then confirmed or revised the initial management plan. The treating anesthesiologist's actual (post-test) patient management was documented in a standardized fashion and compared with the initial (pre-test) management plan.
  
  
  RESULTS
  Thirty-eight patients were included in this case series. Following point-of-care gastric ultrasound, there was a change in either the timing of anesthesia or the anesthetic technique (or both) in 27 patients (71%), with a net change towards a lower incidence of surgical delays.
  
  
  CONCLUSIONS
  This prospective case series suggests that a standardized point-of care gastric ultrasound examination informs anesthesiologists' perceived level of aspiration risk and leads to changes in anesthetic management in a significant proportion of elective patients who did not follow fasting instructions.
authors.affiliation: Department of Anesthesia, Toronto Western Hospital, University of Toronto, University Health Network, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada.|University of Dammam, Dammam, Saudi Arabia.
authors.forename: Husni
authors.initials: H
authors.lastname: Alakkad
authors.affiliation: Department of Anesthesia, Toronto Western Hospital, University of Toronto, University Health Network, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada.
authors.forename: Richelle
authors.initials: R
authors.lastname: Kruisselbrink
authors.affiliation: Department of Anesthesia, Toronto Western Hospital, University of Toronto, University Health Network, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada.
authors.forename: Ki Jinn
authors.initials: KJ
authors.lastname: Chin
authors.affiliation: Department of Anesthesia, Toronto Western Hospital, University of Toronto, University Health Network, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada.
authors.forename: Ahtsham U
authors.initials: AU
authors.lastname: Niazi
authors.affiliation: Department of Anesthesia, Toronto Western Hospital, University of Toronto, University Health Network, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada.
authors.forename: Sherif
authors.initials: S
authors.lastname: Abbas
authors.affiliation: Department of Anesthesia, Toronto Western Hospital, University of Toronto, University Health Network, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada.
authors.forename: Vincent W S
authors.initials: VW
authors.lastname: Chan
authors.affiliation: Department of Anesthesia, Toronto Western Hospital, University of Toronto, University Health Network, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada. anahi.perlas@uhn.ca.
authors.forename: Anahi
authors.initials: A
authors.lastname: Perlas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia / Q000379:methods*; D015331:Cohort Studies; D017558:Elective Surgical Procedures; D005215:Fasting; D005260:Female; D005766:Gastrointestinal Contents; D041981:Gastrointestinal Tract / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D019095:Point-of-Care Systems; D011446:Prospective Studies; D014463:Ultrasonography; D055815:Young Adult