To BURP or Not to BURP?

Application of cricoid pressure during rapid sequence intubation (RSI) to prevent regurgitation and aspiration of stomach contents was proposed by Sellick in 1961. Despite a lack of solid evidence of its efficacy and concern that it sometimes worsens glottic view, the "Sellick maneuver" has become a standard of care. The BURP maneuver (backward, upward, and rightward pressure on the larynx), introduced by Knill in 1993, has been shown to improve glottic view during laryngoscopy. In a prospective, double-blind, randomized, cross-over study, these authors tested the hypothesis that application of the BURP maneuver combined with the Sellick maneuver (together called the modified BURP maneuver) would enhance the glottic view.

In 43 adult patient…