A 64-year-old male bipolar I patient in a severe depressive episode was referred to outpatient electroconvulsive therapy (ECT). Upon admission, at 7 AM of the first day of treatment, both the patient and his wife signed a document confirming the observance of preprocedure fasting, a routine in this hospital. A few minutes later, in the ECT room, when queried again about fasting by the ECT nurse, the patient disclosed having eaten a large solid meal earlier in the morning, overreaching the watchfulness of his family. He also stated that by breaking the necessary fast for ECT, he intended to commit suicide, being killed by a compromised anesthetic procedure. His first ECT treatment was then postponed. 2. Kellner CH, Bryson EO. Electroconvulsive therapy anesthesia technique: minimalist versus maximally managed. J ECT. 2013;29:153-155. 3. Hutchens M, Smith KR. A case of tracheal injury with intubation during electroconvulsive therapy. J ECT. 2009;25:67-69. 4. Berrios GE, Sage G. Patients who break their fast before ECT. Br J Psychiatry. 1986;149:294-295. 5. Cantellow S, Lightfoot J, Bould H, et al. Parents' understanding of and compliance with fasting instruction for pediatric day case surgery.
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