{
  "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.",
  "authors": [
    {
      "affiliations": [
        "Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA",
        "Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA"
      ],
      "name": "Stephen C Haskins"
    },
    {
      "affiliations": [
        "Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA"
      ],
      "name": "Yuriy S Bronshteyn"
    },
    {
      "affiliations": [
        "Duke University Medical Center Library and Archives, Durham, North Carolina, USA"
      ],
      "name": "Leila Ledbetter"
    },
    {
      "affiliations": [
        "Anesthesia and Pain Management, Mount Sinai Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Cristian Arzola"
    },
    {
      "affiliations": [
        "Department of Anesthesiology, Mayo Clinic Jacksonville Campus, Jacksonville, Florida, USA"
      ],
      "name": "Hari Kalagara"
    },
    {
      "affiliations": [
        "Anesthesiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA"
      ],
      "name": "David Hardman"
    },
    {
      "affiliations": [
        "Department of Anesthesiology Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA",
        "Department of Anesthesiology, Weill Cornell Medical College, New York, New York, USA"
      ],
      "name": "Oliver Panzer"
    },
    {
      "affiliations": [
        "Department of Anesthesiology, Weill Cornell Medical College, New York, New York, USA"
      ],
      "name": "Marissa M Weber"
    },
    {
      "affiliations": [
        "Anesthesiology, The George Washington University, Washington, District of Columbia, USA"
      ],
      "name": "Eric R Heinz"
    },
    {
      "affiliations": [
        "Anesthesiology, Stanford Hospital and Clinics, Stanford, California, USA"
      ],
      "name": "Jan Boublik"
    },
    {
      "affiliations": [
        "Western University, London, UK"
      ],
      "name": "Javier Cubillos"
    },
    {
      "affiliations": [
        "Anesthesiology, University of Texas Health Science Center at Houston, Houston, Texas, USA"
      ],
      "name": "Nadia Hernandez"
    },
    {
      "affiliations": [
        "Department of Anesthesiology, University of Utah Health, Salt Lake City, Utah, USA"
      ],
      "name": "Joshua Zimmerman"
    },
    {
      "affiliations": [
        "Anesthesia and Pain Management, Toronto Western Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Anahi Perlas"
    }
  ],
  "title": "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",
  "uid": "6c8861b3-5f0b-5726-bbf7-78c2479e8248"
}