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Value of pre‐operative carotid sinus massage

The usefulness of carotid sinus massage in pre‐operative assessment is discussed with case examples. The technique and risks of carotid sinus massage are described. Carotid sinus massage is of particular value in the demonstration of sino‐atrial and atrioventricular node disease in the absence of definitive abnormalities on the routine resting electrocardiogram, and in the identification of patients who show a hypersensitive response to vagal stimulation. These patients should be identified prior to procedures that involve marked vagal activity, since prolonged sinus arrest may occur.