Canadian Journal of Anaesthesia

, Volume 40, Issue 3, pp 279–282 | Cite as

Difficult laryngoscopy made easy with a “BURP”

  • Richard L. Knill
Anaesthetic Techniques


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.

Key words

Complications: intubation, tracheal Intubation, Tracheal: technique Syndromes: Treacher-Collins 


La mobilisation du larynx vers l’arrière, le haut et la droite par manipulation du cartilage thyroïde peut améliorer la visualisation de la glotte lors d’une laryngoscopie directe difficile. Chez un porteur du syndrome de Treacher-Collins sur lequel la laryngoscopie traditionnelle s’était avérée impossible et l’intubation extrêmement difficile, cette manoeuvre a permis une exposition de la glotte en entier et grandement facilité l’intubation sous vision directe. La même observation s’applique à un patient dont une protusion des incisives supérieures et un maxillaire proéminent présentaient un obstacle sérieux à l’intubation. Ces expériences suggèrent que la manoeuvre déjà décrite peut être utile dans les cas d’intubation difficile sous vision directe.


  1. 1.
    Dubost C, Kaswin D, Duranteau A, Jehanno C, Kaswin R. Esophageal perforation during attempted endotracheal intubation. J Thorac Cardiovasc Surg 1979; 78: 44–51.PubMedGoogle Scholar
  2. 2.
    Olsson GL, Hallen B, Hambraeus-Jonzon K. Aspiration during anaesthesia: a computer-aided study of 185358 anaesthetics. Acta Anaesthesiol Scand 1986; 30: 84–92.PubMedCrossRefGoogle Scholar
  3. 3.
    Caplan RA, Posner KL, Ward RJ, Cheney FW. Adverse respiratory events in anesthesia: a closed claims analysis. Anesthesiology 1990; 72: 828–33.PubMedCrossRefGoogle Scholar
  4. 4.
    Latto IP. Management of difficult intubation.In: Latto IP, Rosen M (Eds.). Difficulties in Tracheal Intubation, London: W.B. Saunders, 1985: 99–103.Google Scholar
  5. 5.
    Wilson ME, Spiegelhalter D, Robertson JA, Lesser P. Predicting difficult intubation. Br J Anaesth 1988; 61: 211–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984; 39: 1105–11.PubMedCrossRefGoogle Scholar
  7. 7.
    Ross EDT. Treacher Collins syndrome — an anaesthetic hazard. Anaesthesia 1963; 18: 350–4.PubMedCrossRefGoogle Scholar
  8. 8.
    Divekar VM, Sircar BN. Anaesthetic management in Treacher Collins syndrome. Anesthesiology 1965; 26: 692–3.PubMedCrossRefGoogle Scholar
  9. 9.
    Sklar GS, King BD. Endotracheal intubation and Treacher Collins syndrome. Anesthesiology 1976; 44: 247–9.PubMedCrossRefGoogle Scholar
  10. 10.
    MacLennan FM, Robertson GS. Ketamine for induction and intubation in Treacher Collins syndrome. Anaesthesia 1981; 36: 196–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Roa NL, Moss KS. Treacher Collins syndrome with sleep apnea: anesthetic considerations. Anesthesiology 1984; 60: 71–3.PubMedCrossRefGoogle Scholar
  12. 12.
    Rasch DK, Browder F, Barr M, Greer D. Anaesthesia for Treacher Collins and Pierre Robin syndromes: a report of three cases. Can Anaesth Soc J 1986; 33: 364–70.PubMedCrossRefGoogle Scholar
  13. 13.
    Williams KN, Carli F, Cormack RS. Unexpected, difficult laryngoscopy: a prospective survey in routine general surgery. Br J Anaesth 1991; 66: 38–44.PubMedCrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists 1993

Authors and Affiliations

  • Richard L. Knill
    • 1
  1. 1.Department of Anaesthesia, University HospitalUniversity of Western OntarioLondonCanada

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