Participants will include patients undergoing elective surgeries requiring general anesthesia with endotracheal intubation. This prospective quasi experimental controlled before and after study will allocate the first 40 patients to Group A and the next 40 patients to Group B, without randomization. Because of the nature of the intervention, the anesthesiologist cannot be blinded, but the outcome assessors and patients will remain blinded to group allocation.

A standardized general anesthesia protocol will be followed for all participants. After fasting as per guidelines and receiving routine premedications, patients will undergo induction with fentanyl, propofol, and rocuronium, followed by endotracheal intubation with a cuffed PVC tube. Cuff inflation techniques will differ between groups. Group A will use pilot balloon palpation based on audible leak, while Group B will have cuff pressure continuously monitored and maintained between 20 to 30 cm H2O at 15 minute intervals. Anesthesia maintenance will include oxygen air mixture with sevoflurane, and muscle relaxation will be maintained with intermittent rocuronium dosing. Sugammadex will be used for reversal at the end of surgery, and postoperative analgesia will include intravenous paracetamol.

Patients requiring more than two intubation attempts will be excluded. Postoperative assessments including sore throat, nausea, vomiting, cough, and hoarseness will be performed at 0, 2, 4, 12, and 24 hours by blinded assessors. Total intubation duration will also be recorded.