What is the BURP maneuver and when is it used?

• A. Backward, Upward, Rightward Pressure on the larynx to improve glottic visualization during laryngoscopy.
• B. Bimanual Upside-Down Repositioning Procedure.
• C. Blunt Ultrasound-guided Robotic Palpation.
• D. Bend, Unfold, Rotate, Push on epiglottis.

Answer: (B)

The BURP maneuver is an external adjustment of the larynx used during direct laryngoscopy to improve the view of the vocal cords. It involves applying backward, upward, and rightward pressure on the larynx (specifically the thyroid cartilage) while the laryngoscope blade is in place. This targeted pressure helps align the airway axes so the glottis becomes more visible, which can turn a poor view into a good one and increase the chances of a successful intubation on the first attempt. It’s performed when the initial laryngoscopic view is suboptimal and should be gentle, coordinated with the blade movement, and released if it worsens the view or causes discomfort or injury. It’s distinct from other maneuvers aimed at preventing regurgitation, and the other listed terms aren’t standard techniques for improving glottic exposure during intubation.