Pulmonary aspiration of gastric contents remains one of the most serious complications in anesthetic practice. Despite advances in fasting guidelines, airway management, and perioperative safety protocols, aspiration continues to contribute substantially to anesthesia-related morbidity and mortality. Preoperative gastric ultrasonography has emerged as an important point-of-care tool for evaluating residual gastric contents and estimating aspiration risk. However, uncertainty remains regarding which ultrasound measurement plane provides the most accurate assessment of gastric volume. A newly published prospective observational study by Liu et al. in Anesthesiology evaluated differences between gastric ultrasound measurements obtained at the abdominal aorta and inferior vena cava (IVC) planes. The findings suggest that neither plane is consistently superior, but selecting the higher-measured gastric volume may yield the most accurate estimate of actual gastric volume and aspiration risk. What is gastric ultrasonography? Gastric ultrasonography is a bedside imaging technique used to estimate gastric content volume and assess the risk of pulmonary aspiration before anesthesia. The examination typically focuses on the gastric antrum while the patient is positioned in the right lateral decubitus position. Clinicians commonly use two anatomical approaches: Abdominal aorta plane Inferior vena cava (IVC) plane Both techniques utilize vascular landmarks to identify and measure the gastric antrum. Why this study matters Current gastric volume prediction models accept measurements from either the abdominal aorta or IVC planes. Previous studies have used: Abdominal aorta plane only IVC plane only Either plane interchangeably However, anatomical differences between these planes may influence gastric volume estimation and potentially affect aspiration risk assessment. The investigators sought to determine: Whether the two measurement planes provide different gastric volume estimates Which plane most accurately reflects the actual gastric volume Whether one approach improves the detection of high aspiration risk patients Study design The researchers conducted a prospective observational study at Guangzhou University of Chinese Medicine. The […]

Introduction The widespread adoption of glucagon-like peptide-1 receptor agonists (GLP-1 RAs), such as semaglutide and tirzepatide, has transformed the management of type 2 diabetes mellitus and obesity. However, emerging evidence is raising important concerns for anesthesiologists and perioperative clinicians. A new clinical study from the Mayo Clinic, published in Anesthesia & Analgesia (2026), provides critical insights into how these medications influence gastric physiology and potentially increase the risk of pulmonary aspiration during anesthesia. What are GLP-1 receptor agonists? GLP-1 receptor agonists are incretin-based therapies that: Enhance glucose-dependent insulin secretion Suppress glucagon release Slow gastric emptying Promote satiety and weight loss Common medications include: Semaglutide Tirzepatide Dulaglutide Liraglutide Their ability to delay gastric emptying is central to both their therapeutic benefits and perioperative risks. Why delayed gastric emptying matters in anesthesia Pulmonary aspiration occurs when gastric contents enter the lungs during anesthesia, potentially leading to: Aspiration pneumonitis Acute respiratory distress syndrome (ARDS) Increased perioperative morbidity and mortality Standard fasting guidelines (e.g., 6–8 hours for solids) aim to minimize this risk. However, GLP-1 RAs may disrupt this safety margin. Study overview Design and population 316 adult patients on GLP-1 RAs Conducted across three Mayo Clinic centers Preoperative evaluation using gastric ultrasound (GUS) Definition of high-risk gastric content Solid food present Or >1.5 mL/kg of gastric fluid volume Key findings High prevalence of residual gastric contents 35.8% of patients had high residual gastric content (RGC) This occurred despite adherence to fasting guidelines Insufficient medication withholding increases risk Patients with high RGC withheld GLP-1 RAs for a shorter duration Critical cutoff: ≤7.5 days before surgery increased risk Fasting duration is crucial Patients with high RGC fasted for shorter periods Critical cutoff: ≤21.3 hours for solid food This is significantly longer than standard fasting recommendations. Opioid use may worsen gastric retention Higher prevalence of recent […]