Doyle P W, Beegun I, Saleh H A
Department of Anaesthesia,Charing Cross Hospital,Imperial College Healthcare NHS Trust,London,UK.
Department of ENT Surgery,Charing Cross Hospital,Imperial College Healthcare NHS Trust,London,UK.
J Laryngol Otol. 2017 Apr;131(4):347-349. doi: 10.1017/S0022215117000068. Epub 2017 Jan 23.
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.
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.
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.
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.
在进行鼻中隔成形术或鼻 septorhinoplasty 时，我们观察到，尽管采用了适当的全身麻醉，但在前鼻中隔或前庭皮肤的鼻粘膜中注射局部麻醉剂（1%利多卡因加 1:80000 肾上腺素）时，患者仍会眨眼。本研究旨在通过对所有接受鼻中隔成形术或鼻 septorhinoplasty 的患者进行前瞻性审计来量化这一现象。
在局部麻醉剂浸润鼻前庭时观察患者的眨眼反射。此时还测量了丙泊酚靶控输注水平、瑞芬太尼速率、脑电双频指数、血压、心率、瞳孔大小和位置以及患者的活动情况。
在观察的 30 名患者中出现了 15 次眨眼反射。眨眼组的平均脑电双频指数值为 32.75（范围 22 - 50），非眨眼组为 26.77（范围 18 - 49）。局部麻醉剂注射时无患者移动。
尽管麻醉深度较深，但仍有 50%的患者出现眨眼反射。如果不了解和认识眨眼反射，这一事件可能会导致要求加深麻醉，但这是不必要的，手术可以安全进行。
