• Jeremiah Tao, William Nunery, Seth Kresovsky, Linda Lister, and Thomas Mote.
• Department of Ophthalmology, University of California, Irvine, California 92697, USA. j.tao@uci.edu
• Ophthal Plast Reconstr Surg. 2008 Nov 1;24(6):465-7.

PurposeA sneeze reflex may occur after propofol sedation and during periocular injections. Unexpected movement from sneezing can result in needle injury to the globe or optic nerve, or hematoma. We investigate the efficacy of concomitant fentanyl or alfentanil in reducing sneezing following propofol and during periocular injections.MethodsOur prospective, randomized study included 81 adult patients undergoing conscious sedation prior to periocular injection of local anesthesia. All patients received propofol and were randomized to propofol only (25 patients), propofol plus midazolam (14 patients), propofol plus opioid (31 patients), propofol plus midazolam and opioid (11 patients). Periocular injection of local anesthetic was given in the usual manner. The main outcome measure was sneezing. Patients were also assessed for cardiorespiratory parameters, analgesia, and adverse side effects of sedatives.ResultsOf the patients who received no opioid, 17 of 39 (43.6%) sneezed. Of the patients who received an opioid, 0 of 42 sneezed (p < 0.0001 by Fisher exact two-tailed test). Among subjects receiving no opioids, midazolam was associated with a higher incidence of the sneeze reflex, but this was not quite statistically significant (p = 0.09). No adverse cardiorespiratory events were noted and analgesia was universally adequate.ConclusionsFentanyl or alfentanil suppressed sneezing after propofol sedation and eyelid anesthetic injection. These medications may prevent needle injury.

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