There are different techniques that anesthesia professionals use during general anesthesia to evaluate endotracheal tube cuff pressure without using a manometer (a manometer is used only with the direct intracuff pressure technique).Such techniques are, for instance, the minimal occlusive volume technique, palpation technique, and minimal leak technique (Stewart, 2003). However, it is questionable whether those techniques provide adequate intracuff pressure measurement or not. There is no standard of practice for intracuff pressure measurement during general anesthesia, even though pressure should be maintained in the recommended interval of 20 to 30 centimeters of water (Trivedi, 2010). The manometer can be a device used during general anesthesia for establishing the endotracheal tube intracuff pressure. Case report A forty-three-year old male, who came to an emergency department after five days of abdominal pain in the right upper quadrant, persistent nausea and vomiting, was scheduled for laparoscopic cholecystectomy surgery under general anesthesia. The patient appeared to be a healthy individual, without any other symptoms than those previously mentioned. He was 180 centimeters (cm) tall, weighed 90 kilograms and had no previous medical or surgical history. The patient was informed about the procedure of general anesthesia using an endotracheal tube (ETT). Following the induction of anesthesia, orotracheal intubation was performed. After a size 7.5 polyvinyl chloride high volume low pressure cuff endotracheal tube was placed, the ETT cuff was inflated with air using the palpation technique. The pilot balloon was palpated as a gross indication of intracuff pressure. 9 millimeters (ml) of volume were injected via the pilot balloon. After confirming and establishing the airway by capnography and bilateral breath sounds, volume control (VC) ventilator settings were programmed. Shortly after applying a tidal volume (VT) of 750 ml, positive end-expiratory pressure (PEEP) of 5 cm water (H2O) and oxygen flow rate of 2 liters (L), the high peak airway pressure of 38 cm H2O was observed. Consequently, the VT was decreased to 600 ml. However, the peak airway pressure remained elevated, at 36 cm H2O. The ventilator setting was then changed from VC to pressure control mode. The peak inspiratory pressure was set at 34 cm H2O, which was able to deliver the tidal volume of 680 ml; however, the high peak airway pressure of 36 cm H2O was still observed. The use of the direct intracuff pressure technique, which required using a manometer to assess intracuff pressure, was not possible in the operating room as no manometer was available. The minimal occlusive volume technique was used instead, as a secondary measurement, to inflate the ETT cuff. A volume of air was injected into the cuff, which eliminated an audible end-inspiratory leak with positive pressure ventilation. Using this technique, the volume of the ETT cuff was decreased from 9 ml to 4 ml. After adjusting the ETT cuff volume, the VC ventilator settings were applied once again, with VT of 750 ml, PEEP 5 cm H2O and oxygen flow rate of 2 L. At this time, the decreased peak airway pressure of 26 cm H2O was observed. The surgery proceeded after the correction of the ETT cuff volume, which subsequently decreased the peak airway pressure. Discussion Anesthesia p