Clinical Application of Point-of-Care Ultrasound Gastric Examination in the Management of an ASA Class 3E Patient: A Case Report.

A 79-year-old ASA class 3 patient scheduled for outpatient testing secondary to prostate cancer, was found to have a previously unknown 10-cm abdominal aortic aneurysm (AAA) causing acute renal insufficiency and hydronephrosis, requiring prompt surgical intervention. The patient was instructed to return to the hospital for further evaluation of the AAA and emergent ureteral stent placement. During the preanesthetic examination, the patient revealed he had eaten a small amount of food before returning to the hospital, placing him at increased risk of pulmonary aspiration. Traditional fasting times would have warranted either a delay in starting the case or performing it under general anesthesia with an endotracheal tube, both at increased risk to the patient. Instead, a point-of-care ultrasound gastric study was performed at the bedside to assess for gastric contents, which revealed the stomach was empty. The case proceeded under monitored anesthesia care without incident. A metallic stent was successfully employed, correcting the hydronephrosis and allowing for further evaluation and treatment of the AAA.