Patients who fulfill the eligibility criteria and  requiring general anesthesia and endotracheal intubation will be included in the study. Dragger machine’s leak test will be passed before induction with systemic leak allowed upto 150 ml/min(as per dragger manual). systemic leak more than this will not be allowed. General anesthesia will be induced using intravenous bolus of induction agents and paralysis will be achieved with succinylcholine or a nondepolarizing muscle relaxant. Flow ratio of 1:1 of oxygen and air will be used. Male patient’s trachea will be intubated with an 8 or 8.5 mm internal diameter ETT and female patient’s trachea will be intubated with a 7.0 or 7.5 mm internal diameter ETT ( portex endotracheal tube) endotracheal tube with low pressure high volume will be used. Anesthesia will be maintained with sevoflurane, a volatile anesthetic agent, in a combination of air and oxygen and without nitrous oxide.  Tidal volume will be pre set as 7 ml/kg. Ventilation will be maintained on volume control mode . ETco2 monitoring will be  mandatory and ETco2 will be maintained between 30 to 35mmhg. PEEP will be allowed upto 10cms of H2O. Patient will be maintained in well relaxed state using muscle relaxant(atracurium or vecuronium) in maintenance dose guided by PNS(peripheral nerve stimulaator).  The routine practice in our institution is that endotracheal intubation is done by anesthesiologist and ETT cuff is inflated by the qualified anesthesia technician/ anaesthesia resident . A 10 ml syringe is used to inflate cuff with 6 cc air as a routine in our instititute. Adequacy of cuff inflation is assessed by palpation of pilot balloon as per satisfication of anaesthesiologiest and no audible leak during inspiration.

These patients will be divided into 2 groups: In group 1, endotracheal tube cuff will be inflated manually by trained OT personnel as mentioned above by palpation of pilot balloon technique. Cuff pressure will be measured after inflation of cuff  and than left as it is for rest of surgery. Cuff pressure will be measured at the end of the surgery before extubation prior to giving reversal agent with cuff pressure manometer (portex cuff inflator/pressure  gauge). Intra operatively cuff will be inflated when anaesthesiologiest feel inadequate cuff pressure on palpating pilot balloon and also on the basis of tidal volume, i.e. if more than 10% of the set tidal volume is lost than cuff will be inflated with 10cc syringe till the pre set tidal volume is achieved. In group 2, cuff will be inflated with cuff manometer and cuff  pressure will be set at  26cm of H2O after intubation. Cuff pressure will than be measured at interval of 15 minutes. If cuff pressure is below 20cm of H2O or above 30 cm of H2O, than it will be reset at 26cm of H2O using cuff manometer. Cuff pressure will be measured at the end of the surgery before extubation prior to giving reversal agent . Number of times the cuff pressure required to be adjusted will be noted in both groups. Intra operatively expired tidal volume will be noted  from display of ventilator and Etco2 value will be noted from multipara monitor during each measurment of ET cuff pressure. In this study,each measurement of cuff pressure will be done by same cuff manometer.

 Post operative complain of sore throat will be measured according to complain of patient on basis of 1 to 4 scale at the time of discharge from the recovery room after achieving adequate recovery room discharge score of  9-10.