Ultrasonographically guided evaluation of the effect of fasting duration on gastric residual volume and aspiration risk in geriatric patients undergoing elective surgery

Objective: This study was conducted to evaluate the effects of preoperative fasting duration on gastric residual volume (GRV) and aspiration risk in geriatric patients scheduled for elective surgery using bedside ultrasonography. The limited literature on the effectiveness of fasting protocols in older age groups increases the importance of this study. Methods: A total of 68 patients aged 65 years and older, classified as ASA I–II, were included in this prospective, cross-sectional study. Patients with ASA III or higher, those with a history of gastrointestinal disease or surgery, pregnant women, and those requiring emergency surgery were excluded. Demographic characteristics, height, weight, and body mass index were recorded for each patient. Preoperative fasting time was determined in hours. The gastric antrum was imaged using ultrasonography in the sagittal plane and in the right lateral decubitus position. Antral-posterior and craniocaudal diameters were measured to calculate the antral area, and then GRV was determined using a validated formula. An GRV of 1.5 kg/ml was considered a high risk of aspiration. Results: The mean age of the patients participating in the study was 71.85 ± 5.23 years, and the mean fasting duration was 13.65 ± 2.48 hours. The mean GRV was 263.52 ml (range, 208.72–421.57). 72.1% of patients had GRV above 1.5 kg/ml and were in the high-aspiration risk group. No statistically significant difference was found between the high-risk and low-risk groups in terms of fasting duration (p > 0.05). A positive correlation was observed between body mass index and GRV (p < 0.05). Conclusion: The detection of significantly elevated GRV in geriatric patients despite long fasting periods consistent with current guidelines suggests that standard fasting protocols may not be sufficient to prevent aspiration risk in this age group. Routine preoperative gastric ultrasonography can help identify at-risk patients and plan appropriate anesthetic management. Furthermore, individualizing fasting periods in elderly patients and avoiding unnecessarily long fasting periods may increase patient comfort and help prevent aspiration complications. Keywords: Geriatrics, gastric residual volume, aspiration risk, ultrasonography, fasting duration.