KUMJ | VOL. 23 | NO. 5 | ISSUE 93 | DECEMBER, 2025

Point of Care (POCUS) Gastric Ultrasound to Predict Gastric Volume in Patients Presenting for Emergency Surgeries
Sharma M, Ghimere P, Yadav B, Dhungel S

Abstract:
Background In emergency surgery, pulmonary aspiration is a significant anesthetic risk. Traditional fasting hours are often unreliable due to physiological stress. This study evaluated the utility of point-of-care gastric ultrasound in assessing gastric volume and content in an emergency Nepalese cohort. Objective To determine the volume, content and cross sectional area of gastric antrum in emergency surgeries and to determine if they are correlated with age, fasting hours, comorbidity, pain score, body mass index and opioid. Method A prospective cross-sectional study of 145 adult patients was conducted. Gastric antral cross-sectional area was measured in the right lateral decubitus position. Gastric volume was calculated using validated formula. Gastric content was noted. These were correlated with variables using univariate and multivariate regression. Result The mean fasting time was 11.05 ± 4.20 hours. However, gastric ultrasound revealed that 42.7% of patients had gastric contents (37.9% clear fluid, 4.8% solids). Furthermore, 21.4% of patients exceeded the high-risk volume threshold of 1.5 mL/ kg. In the multivariate analysis, advanced age (p = 0.003) and higher visual analogue scale score (p =0.03) were independent predictors of gastric volume and gastric cross sectional area. Conclusion Fasting hours are a poor surrogate for gastric emptiness in emergency settings. One in five patients meeting nil per oral criteria remained at high risk for aspiration. We recommend the routine use of preoperative gastric ultrasound, especially in older patients and those with high pain scores, to individualize airway management.
Keyword : Anesthesia, Aspiration pneumonia, Emergency surgery, Gastric ultrasonography, Point-of-care ultrasound