The Doyle-Saleh blink reflex.

The Doyle-Saleh blink reflex.

J Laryngol Otol. 2017 Jan 23;:1-3

Authors: Doyle PW, Beegun I, Saleh HA

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.

PMID: 28112062 [PubMed - as supplied by publisher]

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