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The Doyle–Saleh blink reflex

Published online by Cambridge University Press:  23 January 2017

P W Doyle ,
I Beegun  and
H A Saleh
P W Doyle*
Affiliation:
Department of Anaesthesia, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
I Beegun
Affiliation:
Department of ENT Surgery, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
H A Saleh
Affiliation:
Department of ENT Surgery, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
*
Address for correspondence: Dr Patrick W Doyle, Department of Anaesthesia, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, UK Fax: +44 (0) 20 8846 7587 E-mail: [email protected]
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Abstract

Objectives:

When performing septoplasty or septorhinoplasty, we have observed that patients blink on injection of local anaesthetic (lidocaine 1 per cent with adrenaline 1:80 000) into the nasal mucosa of the anterior septum or vestibular skin, despite appropriate general anaesthesia. This study sought to quantify this phenomenon by conducting a prospective audit of all patients undergoing septoplasty or septorhinoplasty.

Methods:

Patients were observed for a blink reflex at the time of local anaesthetic infiltration into the nasal vestibule. Also measured at this point were propofol target-controlled infusion levels, remifentanil rate, bispectral index, blood pressure, heart rate, pupil size and position, and patient movement.

Results:

There were 15 blink reflexes in the 30 patients observed. The average bispectral index value was 32.75 (range, 22–50) in the blink group and 26.77 (range, 18–49) in the non-blink group. No patients moved on local anaesthetic injection.

Conclusion:

The blink reflex appears to occur in 50 per cent of patients, despite a deep level of anaesthesia. Without an understanding and appreciation of the blink reflex, this event may result in a request to deepen anaesthesia, but this is not necessary and surgery can proceed safely.

Keywords

Blink ReflexNasociliary NerveSeptoplastyRhinoplasty
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 131 , Issue 4 , April 2017 , pp. 347 - 349
Copyright
Copyright © JLO (1984) Limited 2017 

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References

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