The Doyle-Saleh blink reflex

Area of Science:

• Anesthesiology
• Otolaryngology
• Surgical Procedures

Background:

• Septoplasty and septorhinoplasty commonly involve local anesthetic infiltration.
• A patient blink reflex during this infiltration has been anecdotally observed despite general anesthesia.

Purpose of the Study:

• To prospectively quantify the incidence of the blink reflex during local anesthetic injection in patients undergoing septoplasty or septorhinoplasty.
• To correlate the blink reflex with anesthetic depth and other physiological parameters.

Main Methods:

• Prospective audit of patients undergoing septoplasty or septorhinoplasty.
• Observation of blink reflex upon local anesthetic infiltration into the nasal vestibule.
• Monitoring of anesthetic depth (propofol, remifentanil, bispectral index), vital signs, and patient movement.

Main Results:

• A blink reflex was observed in 15 out of 30 patients (50%).
• The average bispectral index was slightly higher in the blink group (32.75) compared to the non-blink group (26.77).
• No patient movement was recorded during local anesthetic injection.

Conclusions:

• The blink reflex occurs in approximately 50% of patients during nasal local anesthetic infiltration for septoplasty/septorhinoplasty, irrespective of deep anesthesia.
• Awareness of this reflex is crucial to avoid unnecessary deepening of anesthesia.
• Surgery can safely proceed despite the presence of the blink reflex.