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It depends.

If you are not paralyzed, checking eyelash reflex is fine. I usually talk to patients as they fall asleep and joke that they need to tell me when they fall asleep. It is funny to me because when they stop talking, they actually are telling me they are asleep.

Now once a patient is asleep, we often need to paralyze their muscles for surgery. Once that is done, it is much more difficult to know they are asleep.

It the past anesthesiologists would look for tearing, elevated heart rate and hypertension. Today we have two very good ways to insure patients are asleep.