Fasting before general anaesthesia aims to reduce the volume and acidity of stomach contents, thus reducing the risk of regurgitation and aspiration. Recent guidelines have recommended a shift in fasting policies from the standard ‘nil per oral from midnight’ to a more relaxed policy of clear fluid intake a few hours before surgery. The effect of preoperative oral administration of 150 ml of water 2 h prior to surgery was studied prospectively in 100 ASA I and II patients, for elective surgery. Patients were randomly assigned to two groups. Group I (n = 50) was fasting overnight while Group II (n = 50) was given 150 ml of water 2 h prior to surgery. A nasogastric tube was inserted after intubation and gastric aspirate was collected for volume and pH. The gastric fluid volume was found to be lesser in Group II (5.5 ± 3.70 ml) than Group I (17.1 ± 8.2 ml) which was statistically significant. The mean pH values for both groups were similar. Hence, we conclude that patients not at risk for aspiration can be allowed to ingest 150 ml water 2 h prior to surgery.

A 30-year-old man presented for advice regarding a benign naevus. He gave an incidental history of tingling and pain on his palms within minutes of contact with water, lasting approximately 30 min. Warm water triggered the symptoms more rapidly than cold water. His soles were not affected. Mild axillary and palmar hyperhidrosis was reported. Sweating on his palms after exercise could trigger the symptoms. He was otherwise fit and well, with no upper ⁄ lower respiratory or gastrointestinal symptoms. There was no history of atopy or other medical problems, and he was not on any medication.Examination revealed a 70-kg man with normal palms and soles. Immersion of his hand in water produced symptoms in 75 s with visible flesh-coloured papules (Fig. 1). Appearance reverted to normal after 20 min. Longer immersion produced symptomatic lesions of longer duration, up to 35 min. Oral antihistamines were of no benefit.What is your diagnosis? Figure 1 Confluent flesh-coloured papules seen on left palm after 2 min exposure to warm water.

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