Ультразвуковое исследование выявило в желудке пациента два мишурных мишек, съеденных за два часа до госпитализации

He Said He Had Fasted 14 Hours, Then an Ultrasound Found Two Gummy Bears in His Stomach A 52-year-old man arrived at the hospital with foul-smelling ulcers on both lower legs, a fever, a racing heart, and lab results pointing toward sepsis. He needed the wounds cut away urgently. During the pre-anesthesia interview, he said his last real meal had been more than 14 hours earlier. Then he mentioned the gummy bears he had eaten about two hours before he got there. Because he also had diabetes, which can slow stomach emptying, the anesthesia team ran a bedside ultrasound of his stomach rather than taking the fasting history at face value. Two bright, solid-looking structures sat in the gastric antrum. They were the candy. The case was published January 10 in Cureus by anesthesiologists at United Health Services in Binghamton, New York, and the University of Minnesota. Two Bright Shapes in the Gastric Antrum The scan itself was routine. A curvilinear probe went on the upper abdomen in a sagittal orientation, marker toward the head. The left lobe of the liver and the gastric antrum came into view, and inside the antrum sat two echogenic solid structures. Point-of-care gastric ultrasound is used to classify stomach contents as empty, liquid or solid and to estimate volume from the cross-sectional area of the antrum. Under the assessment framework described by Perlas and colleagues, visible solid material, or a calculated volume above 1.5 mL per kilogram, puts a patient in the high-risk category for aspiration. Aspiration of stomach contents during anesthesia is uncommon but consequential. A closed claims analysis in Anesthesiology documented outcomes including pneumonitis, pneumonia, sepsis, and the need for mechanical ventilation. The technique has proved especially useful for patients who cannot give a reliable fasting history: young children and adults with cognitive or verbal impairment. This case is a reminder that a fully articulate adult can also give an incomplete one, not out of deception but because candy does not register as food. The scan is quick, uses no radiation, and can be done at the bedside minutes before induction. Reference guidance on interpreting the images is publicly available. Why the Team Changed the Anesthetic Plan In an elective case, solid stomach contents usually mean the surgery waits. This man's sepsis was progressing, so waiting was not on the table. The team performed a rapid sequence induction with cricoid pressure. After preoxygenation, anesthesia was induced with lidocaine, propofol, and succinylcholine. Bag-mask ventilation was avoided, and the trachea was intubated using video laryngoscopy. No aspiration occurred, the operation was uneventful and the patient was extubated at the end. Rapid sequence induction carries its own risks, including blood pressure instability. The authors argue the ultrasound gave them objective grounds for choosing it. The 97-Doctor Survey That Found No Agreement Alongside the case, the authors surveyed 97 anesthesiologists about gummy bears before elective procedures. More than half had over a decade of clinical experience. About 85 percent said they had access to equipment capable of performing gastric ultrasound. Only 32 percent said they had the skills to independently assess aspiration risk with it. That gap between owning the machine and being able to use it for this purpose is the survey's most striking finding. On management, 83 percent said they would change their anesthetic approach if gummy bears turned up on a preoperative scan. On timing, roughly 40 percent said they would wait less than four hours before proceeding. The rest were spread across longer intervals, which is another way of saying the profession has not settled the question. What the Fasting Rules Actually Say About Candy American Society of Anesthesiologists fasting guidance sets windows running from two to eight hours depending on what was eaten. A modular update published in 2023 addressed carbohydrate-containing clear liquids, chewing gum and pediatric fasting, and advised against delaying surgery in healthy adults who chew gum as long as they do not swallow it. The gum recommendation is instructive: it exists because clinicians kept asking, and because someone eventually looked at whether the delay was justified. Gelatin-based candy is not addressed anywhere in that framework. The authors write that waiting four to six hours may be reasonable in low-risk patients, while noting the optimal interval remains unclear, especially in people with delayed gastric emptying. For a patient whose stomach already empties slowly, that uncertainty is not academic. They also flag ingredients worth thinking about. Gummy bears combine sugar, corn syrup, starch, flavoring, coloring, citric acid and in some formulations beeswax. The authors reason that citric acid could raise gastric acidity and worsen chemical pneumonitis if aspirated, and that beeswax could contribute to lung inflammation. That is a mechanistic argument drawn from composition, not something this case tested. The limits are worth stating. This is one patient, and the survey captured what 97 clinicians say they would do rather than what happens to patients. Neither establishes how long gelatin candy actually lingers in the stomach. What the case does show is that a handful of candy can be visible on ultrasound hours later, and that an honest answer to a question about the last meal may not include everything a patient swallowed. Key Questions Answered What did the ultrasound actually show? Two echogenic solid structures inside the gastric antrum, consistent with the gummy bears the patient reported eating about two hours before arriving at the hospital. Why did that matter if he had fasted 14 hours? Solid material in the stomach raises the risk of aspirating gastric contents during anesthesia. His diabetes added concern because it can slow stomach emptying. Do fasting guidelines cover candy like this? Not specifically. ASA guidance sets fasting windows by food type and addresses chewing gum, but the authors note there is no dedicated recommendation for gelatin-based foods. How long should someone wait after eating gummy bears? No consensus exists. The authors suggest four to six hours may be reasonable for low-risk patients, and about 40 percent of surveyed anesthesiologists said they would wait under four hours. Was the surgery delayed? No. The patient was septic and needed urgent debridement, so the team used a rapid sequence induction with cricoid pressure instead of postponing. What should patients tell their anesthesia team? Everything they consumed, including candy, mints, gum, and supplements, with timing. Small intakes patients consider trivial can change the plan. Published by Medicaldaily.com