Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Aug 8;24(1):226.
doi: 10.1186/s12893-024-02519-8.

Factors predicting the use of the backward upward rightward pressure maneuver in thyroid surgery: a single-center retrospective cohort study

Filiz Alkaya Solmaz  1 , Eyyüp Sabri Özden  2
Affiliations

Factors predicting the use of the backward upward rightward pressure maneuver in thyroid surgery: a single-center retrospective cohort study

Filiz Alkaya Solmaz et al. BMC Surg. .

Abstract

Background: The purpose of this study was to evaluate the predictability of utilizing the backward upward rightward pressure (BURP) maneuver and the efficacy of related tests in patients with a challenging airway and a Mallampati score of 2 or higher who underwent scheduled elective thyroid surgery.

Methods: Patient files were scanned for 300 adult patients who had undergone thyroid surgery under general anesthesia. The information included their medical history of thyroid disease, previous thyroid surgery, and evaluation tests for difficult intubation such as Mallampati score, maximum mouth opening, ease of intubation, thyroid goitre grade, and whether the BURP maneuver was performed. Patients who had a history of difficult intubation or a Cormack Lehane score less than 2 were excluded. Additionally, the patients were divided into two groups: one group underwent the BURP maneuver (n = 78) and the other did not (n = 56).

Results: Statistically significant differences in the maximum mouth openings and thyroid goitre grade were observed between the groups according to the preoperative evaluation. Furthermore, significant differences were noted between the groups in terms of the ease of intubation, intubation time, Cormack-Lehane score, and number of intubation attempts.

Conclusion: There may be a correlation between the maximum mouth opening and thyroid goitre grade in predicting the use of the BURP maneuver. It is important to keep in mind, however, that difficult intubation may occur in some uncommon types of goiter, such as retrosternal goiter, even if the thyroid gland size is small. Therefore, it may be useful to consider performing the BURP maneuver.

Keywords: Anesthesia; BURP maneuver; Goitre; Prediction.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study flow chart and outcomes of the included patients
Fig. 2
Fig. 2
ROC analysis of ease of intubation score, intubation time and maximum degree of mouth opening
See this image and copyright information in PMC

References

    1. Tamire T, Demelash H, Admasu W. Predictive values of preoperative tests for difficult laryngoscopy and intubation in adult patients at Tikur Anbessa Specialized Hospital. Anesthesiol Res Pract. 2019;1790413. 10.1155/2019/1790413. - PMC - PubMed
    1. Yu T, Wu R-R, Longhini F, et al. The BURP maneuver improves the glottic view during laryngoscopy but remains a difficult procedure. J İnternational Med Res. 2020;48(5):1–12. - PMC - PubMed
    1. Kaniyil S, Anandan K, Thomas S. Ratio of height to thyromental distance as a predictor of difficult laryngoscopy: a prospective observational study. J Anesthesiol Clin Pharmacol. 2018;34:485–9.10.4103/joacp.JOACP_283_17 - DOI - PMC - PubMed
    1. Kumar A, Dutta S, Singh J, et al. Clinical measurement of maximal mouth opening in children: a pioneer method. J Clin Pediatr Dent. 2012;37(2):171–6. 10.17796/jcpd.37.2.l17x8227682j5610 - DOI - PubMed
    1. Zawawi KH, Al-Badawi EA, Lobo SL, et al. An index for the measurement of normal maximum mouth opening. J Can Dent Assoc. 2003;69:737–41. - PubMed

LinkOut - more resources