Abstract
2002; Springer Science+Business Media; Volume: 49; Issue: S1 Linguagem: Inglês
10.1007/bf03018138
ISSN1496-8975
AutoresDouglas D. Snider, Brendan T. Finucane, Donna Clarke, Joel Loiselle, Greg J. Doak, Brady Anderson, Dan Wood, Sandy Shysh, M Perrault, Philippe Chouinard, François Fugère, François Girard, Monique Ruel, Wendy C. E. Hall, Jiri Hrazdil, Donald T. Jolly, John C. Galbraith, Maria Greacen, Alexander S. Clanachan, Duminda N. Wijeysundera, W. Scott Beattie, Michelle Chochinov, Stephen H. Halpern, Dolores M. McKeen, Robert T. Nunn, Brendan S. Barrett, G. Allen Finley, Susan E. Buffett-Jerrott, Sherry H. Stewart, Donna Millington, Keyvan Karkouti, Y. Raja Rampersaud, Stuart A. McCluskey, Lucia Evans, Mohammed Ghannam, Nizar N. Mahomed, Sudha Singh, Patricia Morley-Forster, Mohammed Shamsah, Ian R. Thomson, Aaron D. Brown, Jeffrey I. Freedman, Robert J. Hudson, Murray Hong, Sean R. R. Hall, Brian Milne, Louie Wang, Chris Loomis, Ian Gilron, Debbie Tod, Allan C. Bell, Elizabeth Orr, Gary Dobson, Mustafa Karamanoglu, John V. Tyberg, Frances Chung, Charles Imarengiaye, Angela Rocchi, Lindy Forte, Elizabeth G. Van Den Kerkhof, David Goldstein, M. A. Rimmer, Hoi Kwan Lee, Isabelle Charest, René Martin, François Plante, Shaheen Shaikh, Damian Yung, Mark Bernstein, Ngozi Imasogie, David Wong, Ken Luk, Suntheralingam Yogendran, Atul Prabhu, Ayman Hendy, Glenn McGuire, Jean Wong, M. Denise Daley, Peter H. Norman, Una Srejic, Thomas B. Dougherty, Sarah Hogervorst, Thomas M. Hemmerling, Joachim Schmidt, Pierre Beaulieu, Klaus Jacobi, Pamela H. Lennox, Kelly Mayson, Toshimi Arai, Kaori Saito, Masao Yamashita, Alain Gauthier, Daniel Boudreault, Dominique Girard, Louie T. S. Wang, Nancy Sikich, Guy C. Pétroz, Jerrold Lerman, Gregory M. T. Hare, Andrew Baker, Kathryn M. Hum, Steve Y. Kim, Aiala Barr, C. David Mazer, Terrance A. Yemen, Thomas Howlett, Andrew Baker, Nicholas Phan, Navindra Persaud, Min Zhao, Elaine Liu, Michael G. Fehlings, Davinia E. Withington, Tareq M Al-Ayed, G. M. Davis, David M. Ansley, Baljinder S. Dhaliwal, Zhengyuan Xia, Anthony M.‐H. Ho, Anna Lee, Elizabeth Ling, Alan Daly, Kevin Teoh, Theodore E. Warkentin, David V. Godin, Thomas K. H. Chang, Joanne Fortier, Fadi Basile, Ignacio Priéto, C. David Mazer, Peter C. Duke, Barry A. Finegan, Davy Cheng, Richard Hall, B. Lim, Jack Shannon, Chiu‐Ming Ho, Shen‐Kou Tsai, Margaret Srebrnjak, Vivien Walsh, Geena Joseph, Teresa Valois Gomez, Carmen Rivero Fuenmayor, Paul Bach, Allaudin A. Kamani, Joanne Douglas, M. D. Esler, V. Gunka, Pamela Angle, Sam Tang, D. Thompson, Jean E. Kronberg, A. George Morgan, Craig H. Leicht, Ivan Veličković, David T. Raphael, Maxim Benbassat, D Arnaudov, Alex Bohorquez, Bita Nasseri, D. John Doyle, J Kolman, Ian Keith, Pamela J. Morgan, Doreen Cleave‐Hogg, Susan Eveleigh, Jordan Tarshis, Sharon Davies, John Doyle, Heather Lee Loughlin, J. Patrick O’Connor, John Dolman, Fred S. Mikelberg, Gordana Dulovic, Brian G. Feagan, Cindy J. Wong, Alexandra Kirkley, D. W. C. Johnston, Frank C. Smith, Paul Whitsitt, William Li Pi Shanl, Steven B. Backman, Jeffrey Barkun, Peter Metrakos, J TCHERVENKOV, Mary Jane Salpeter, Leah Jamnicky, Michael A.S. Jewett, Ramiro Arellano, Brian Muirhead, Saifundin Rashiq, Meera Shah, Vikki Wilkinson, Samantha Woolsey, Barry A. Finegan, Carol Fiorilli, Joel L. Parlow, Nicole Avery, Baljinder S. Dhaliwal, George Djaiani, Jayanta Muhkerji, Jacek Karski, Jo Carroll, Stuart McCluskey, Linda M. Harris, Jan Paton, Emmanuel Kanetos, William G. Williams, Elizabeth G. Van Den Kerkhof, Brian Milne, W. Scott Beattie, Cristina Hurtado, Barry A. Finegan, Manoj Gandhi, Sandy Clanachan, Woo Jong Shin, D. Winegar Bruce, Jae Hang Shim, Woo Jae Jeon, Kyung Hun Kim, Bing Wang, David P. Archer, Naaznin Samanani, Sheldon H. Roth, Claudia Coimbra, Manon Choinière, Denis Babin, François Donati, Pamela H. Lennox, Cynthia L. Henderson, John H. P. Friesen, Michael J. Jacka, Alan Cheng, Finlay A. McAlister, Jessie A. Leak, Tao Bui, Dy Tien Nguyen, Alicia Kowalski, Keruyi Popat, Henry M. Kuerer, Paul Serowka, Kim Turner, Brian Milne, Ted Ashbury, Tianlong Wang, Driss El-Kebir, Bernard Hubert, Ruud A. W. Veldhuizen, Dominique Gauvin, Gilbert Blaise, Fan Yang, Patricia Amicone,
ResumoPrevious studies have shown that the 'BURP' maneuver improved glottic view, when applied to the thyroid cartilage.(1) We hypothesized that backward, upward and rightward pressure on the cricoid cartilage would combine benefits of both 'BURP' and Sellick's maneuver (2), improving glottic view and offer potential protection against passive regurgitation. M ME ET TH HO OD DS SWe analyzed glottic view data from 40 adults undergoing elective surgery, in this prospective, randomized, double blind and crossover study.Patients at risk for regurgitation or with difficult airways were excluded.Patients were induced with fentanyl, propofol and rocuronium.In a random sequence for each case, and blinded by a sheet to the laryngoscopist, an anesthetic technician applied 30 newtons of direct, 'BURP', or no pressure to the patients cricoid cartilage.A separate laryngscopy was conducted for each maneuver and the views were graded as being good (part of the glottis seen), poor (the arytenoids were seen) and no view (only the epiglottis was seen).After the third maneuver the airway was secured with an endotracheal tube.The same anesthetic technician applied the pressures and the same laryngoscopist assessed the glottic views through the study.Views were recorded and blinding was maintained until the conclusion of the study.Differences were analyzed using the Wilcoxon Signed Rank test. R RE ES SU UL LT TS SThe hypothesis was rejected and 12/40 (30%) of the patients having 'BURP' applied to the cricoid cartilage showed a worse view (p=0.007), while only 2/40 (5%) showed an improved view.Direct cricoid pressure made the view worse in 5/40 (12.5%) of the patients, which was not statistically significant (p=0.279) and only 1/40 (2.5%) showed an improved view.No difference was seen in 26/40 (65%) of the patients. D DI IS SC CU US SS SI IO ON NThe'BURP' maneuver worsens glottic view when applied to the cricoid cartilage.There would be no benefit in routinely applying 'BURP' to the cricoid cartilage, during rapid sequence inductions.Second, proper application of cricoid pressure is important to prevent an obstructed view of the glottis.Finally, there may be situations where cricoid pressure could be removed to get a better view.
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