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t \ hcalthy, 70-kg, 22-ycar-old nian \rns aclmittccl sis clays prior to operation following tritiiniii to the Iiciicl i t n c l fiicc ciuisctl by hloros inflictccl with ;I Ici~tl pipc. Injuries incluclccl hasiliir skull frilcttlrc wi th ccrchrospiitiil Iluiel otorrhca i i n d rhinorrhcii iuitl :I niilcl ccrc1)rid concussion. I'lic ncurologic itlmorniiilitics hi ic l rcsol\~ccl prior to opcriition. Also prcscnt wcrc estcnsivc facial fractures, schctlulccl for corrcction. Thcsc inclutlccl it ni;ineliIiular frac~urc, right zygoniiitic friicturc, intritorhitiil I'riicturcs (including a blowout frncturc o f the right orbitid floor), comminutctl friicturc of thc right niasilh ry sinus, friicturc o f thc lcli niiixillary sinus, ancl a niisocthmoicl complcs friicturc with ;I postcriorly clisplitcccl midtiice. Alicr prcmcdiciition with diiizepiini, 15 nig, iiclministered orally ;it 8:OO AM, iincsthcsiit \ w s inclucccl 70 niiniitcs later with tliiopcntnl, 300 ing, iui t l succiiiylclioliiic, iv. Tlic triichcii \\*as ciisily intuliatccl with i111 8.0-inn1 orotriiclicitl tulic i incl iincsthcsiit w i t s maintainctl with liitlothiinc, nitrous ositlc, i tnc l osygcn. The piiticnt rcccivccl no ittropinc or othcr itntichnlincrgic elrug for Iminctliciition or inelriction. Alonitors iiiclutlccl ;in clcctrociirelioscopc with cligital rciitlout of hciirt riitc. A trachcostomy WIS pcrformccl iincl thc iincsthctic iiclniinistcrccl via ii tri~chcostomy tubc with spontaiicous wntilation. Thc second part of thc procedure, open rctluction anel intcrnitl fisiition of ihc kicial fractures, was then licgun. About I hour, 45 niinutes iiftcr incluciion, thc R o w inipiiction forceps \wrc inscrtcd into the nasiil cavity i inc l mouth to griisp thc postcrioily clispliiccd miisillii iuitl pull i t for\v;ircl. At this time the paticnt's pulsc riitc w i t s 901niin. It had been stablc sincc induction of iinesthcsia. With application of iinteriorly and cautlally directed forcc to the maxilla, sinus briiclyciircliii to 5411nin iibruptly clc\~clopccl. Blooel pressurc, which hael been 98 torr systolic, fell to 90 tom. When triiction was rclciisctl iiftcr iibout 20 seconds thc heart ratc rapiclly rcturnctl to normal i incl stahilizetl ;it iihout 86/min. Tlic rcinaintlcr of thc iincsthctic coursc \V;IS uneventful.

Oculocardiac Reflex Caused by Midface Disimpaction