“…We do not think that reducing rectal midazolam is warranted in exchange for unsatisfactory sedation to prevent an unusual transient problem with eye opening, the incidence of which has not been determined. It should be noted that besides the known effects on muscular relaxation, there are reports on muscular activation under propofol anaesthesia which suggest involvement of subcortical brain structures rather than peripheral mechanisms (Saunders & Hams 1990;Fierobe et al 1991). Propofol attenuates synaptic transmission in the spinal cord (Yamamura et al 1991), but eye opening and ocular movement are controlled by supraspinal centres.…”