Poster Presentation: Gastric Antrum POCUS Preanesthetic Assessment in Upper Endoscopy Patients on GLP-1 Agonists to Prevent Pulmonary Aspiration-Gastric Antrum POCUS Preanesthetic Assessment in Upper Endoscopy Patients on GLP-1 Agonists to Prevent Pulmonary Aspiration

Gastric Antrum POCUS Preanesthetic Assessment in Upper Endoscopy Patients on GLP-1 Agonists to Prevent Pulmonary Aspiration

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The document discusses the application of gastric antrum point-of-care ultrasound (POCUS) as a preanesthetic assessment tool for patients undergoing upper endoscopy, particularly those on GLP-1 agonists. The study identifies that while fasting guidelines are typically followed, patients on GLP-1 agonists can still present with significant residual gastric contents, increasing the risk of pulmonary aspiration. A literature review indicates that although fasting is generally effective, GLP-1 agonists can inhibit gastric emptying leading to increased risks.<br /><br />The methods section outlines how literature was reviewed using databases such as PubMed and EMBASE, initially yielding 189 results, and then narrowed down to relevant studies by including the term 'fasting' and focusing on specific articles related to upper endoscopy and GLP-1 agonists. <br /><br />The introduction emphasizes the high risk of pulmonary aspiration associated with upper endoscopy procedures, especially in patients on GLP-1 agonists. Gastric antrum POCUS is highlighted as an accurate and feasible tool that can mitigate these risks without disrupting procedure schedules.<br /><br />The purpose of the case report is to demonstrate the effectiveness of gastric ultrasound in identifying patients with a full stomach prior to endoscopy, thereby preventing aspiration. Recommendations advocate for the routine implementation of gastric antrum POCUS, particularly for patients taking GLP-1 agonists or those with conditions that cause gastroparesis. <br /><br />The case summary discusses a specific instance involving a 49-year-old female patient on Trulicity (a GLP-1 agonist) who despite following fasting guidelines, had a full stomach (detected via endoscopy and later suggested could have been pre-emptively identified with POCUS). The anesthesia team’s decision to use rapid sequence induction (RSI) proved successful, though the report suggests that an ultrasound could have informed and possibly altered the decision-making process more effectively.<br /><br />Overall, the document underscores the importance of integrating gastric POCUS into preanesthetic assessments for improving patient safety and reducing the risk of pulmonary aspiration in upper endoscopy procedures.

Keywords

gastric antrum POCUS

preanesthetic assessment

upper endoscopy

GLP-1 agonists

pulmonary aspiration

gastric emptying

fasting guidelines

gastroparesis

rapid sequence induction

patient safety