Comparison of jaw thrust and backward-upward-rightward pressure (BURP) manoeuvre with conventional technique on glottic visualization and intubation characteristics using C-MAC video-laryngoscope.

Abstract

Background and aims: Traditionally various methods have been employed to improve glottic visualization during laryngoscopy, namely backward-upward-rightward pressure (BURP) and jaw trust with promising results. The current study aims to compare these maneuvers for the enhancement of glottic visualization during video laryngoscopy.

Material and methods: In this prospective randomized study in 120 adult patients with normal airways, C-MAC® laryngoscopy was performed under general anesthesia (GA). Images of the glottis with conventional laryngoscopic technique, using BURP maneuver and jaw thrust were acquired, and Cormack-Lehane (CL) grading, percentage of glottic opening (POGO) score, and approximate glottic area were recorded from the images. Subsequently, patients were divided into three equal groups-in group C, the trachea was intubated using conventional laryngoscopic technique, in group B, BURP was used, and in group J, jaw thrust was used. Intubation time, ease of intubation, number of intubation attempts, incidence of airway trauma, and postoperative sore throat were noted.

Results: Both jaw thrust and BURP maneuvers improved CL grading, POGO score, and glottic area significantly as compared to the conventional laryngoscopic technique. CL grading and POGO score were better with BURP than with jaw thrust; however, the glottic area improved more with jaw thrust. Jaw thrust also resulted in statistically significant lower intubation time and better ease of insertion score. Intubation was successful in the first attempt in all patients and there was no airway trauma and postoperative sore throat.

Conclusion: Both BURP and jaw thrust maneuvers result in better glottic visualization. Jaw thrust provides lower intubation times, better ease of intubation scores, as well as a higher visualized glottic area than BURP.