Difficult laryngoscopy made easy with a "BURP"

Can J Anaesth. 1993 Mar;40(3):279-82. doi: 10.1007/BF03037041.


Displacement of the larynx by backward, upward and rightward pressure on the thyroid cartilage or "BURP" may improve visualization of the glottis in some cases of difficult direct laryngoscopy. In a patient with the Treacher-Collins syndrome in whom conventional laryngoscopy had proved impossible and tracheal intubation extremely difficult, this manoeuvre exposed the entire glottis and made tracheal intubation under direct vision easy. In a patient with protruding upper incisors and a prominent premaxilla which precluded a view of the glottis by conventional laryngoscopy, "BURP" again revealed the glottic opening and simplified the placement of an endotracheal tube. This experience suggests that "BURP" be considered as a potential aid in the management of difficult direct laryngoscopy.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Child
  • Epiglottis / pathology
  • Female
  • Glottis / pathology
  • Humans
  • Incisor / pathology
  • Intubation, Intratracheal* / methods
  • Laryngoscopes
  • Laryngoscopy / methods*
  • Larynx / anatomy & histology
  • Malocclusion / pathology
  • Mandibulofacial Dysostosis / pathology
  • Pressure
  • Thyroid Cartilage / anatomy & histology*