Discussion

3 out of 7 patients were found to have full stomachs despite being appropriately NPO. This aligns with existing evidence suggesting delayed gastric emptying in GLP1a users. Furthermore, the patients with full stomachs were those who held their GLP1a less than 1 week or had ongoing gastrointestinal symptoms. This supports the ASA recommendations that patients may benefit from holding their GLP1a one week in advance of an elective procedure. However, more rigorous trials exploring the optimal duration of withholding are necessary. Other areas of future interest include the effect of dosage, duration of therapy, tachyphylaxis to delayed emptying, altered NPO guidelines, and stratification between weekly and daily users.

Our case series illustrates how gastric ultrasound can be a useful tool to increase safety, by identifying those who should reschedule an elective procedure or who may need a rapid sequence induction. Additionally, it can help reduce blanket cancellations and unnecessary general anesthesia exposure by confirming those who have empty stomachs despite receiving their last GLP1a dose. Finally, the utility of gastric ultrasound, much like other POCUS modalities, is user dependent and qualitative interpretation can be subjective. This highlights the importance of current providers being comfortable with the technique and the need for teaching it to future providers who will increasingly encounter these patients.