The Doyle-Saleh blink reflex.

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.