Anaesthesia · Airway Management (Difficult Airway, Intubation, Airway Devices)

BURP (Backward, Upward, Rightward Pressure) manoeuvre is applied during direct laryngoscopy. Which structure is being externally manipulated to improve the laryngoscopic view?

  • A Hyoid bone
  • B Cricoid cartilage
  • C Thyroid cartilage ✓
  • D Arytenoid cartilages
Correct answer: C. Thyroid cartilage

Explanation

BURP involves the assistant applying external pressure to the thyroid cartilage — backward (posteriorly against the cervical vertebrae), upward (cranially), and rightward (toward the patient's right) — to bring the glottis into the laryngoscopist's line of sight. This differs from cricoid pressure (Sellick's manoeuvre), which compresses the cricoid ring posteriorly against the oesophagus to prevent passive regurgitation. BURP can improve a Cormack-Lehane Grade 3 view by up to 2 grades. The hyoid bone is not directly accessible for this purpose; arytenoids are cartilages within the larynx.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

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