[2] As the name implies, the BURP manoeuvre requires a clinician to apply pressure on the thyroid cartilage posteriorly, then cephalad (upwards) and, finally, laterally towards the patient's right.
The technique involves the application of backward pressure on the cricoid cartilage with a force of 20–44 newtons[5] to occlude the esophagus, preventing aspiration of gastric contents during induction of anesthesia and in resuscitation of emergency victims when intubation is delayed or not possible.
[7] The initial article by Sellick was based on a small sample size at a time when high tidal volumes, head-down positioning and barbiturate anesthesia were the rule.
[8] Beginning around 2000, a significant body of evidence has accumulated which questions the effectiveness of cricoid pressure, and the application may in fact displace the esophagus laterally[9] instead of compressing it as described by Sellick.
[26] The initial proposal of cricoid pressure as a useful clinical procedure, its subsequent adoption as the lynchpin of patient safety, and its current decline into disfavor represents a classic example of the need for evidence-based medicine, and the evolution of medical practice.