PURPOSE: To assess the comparable applicability of four methods of endotracheal tube cuff (ETTc) inflation on the basis of optimal level of intracuff pressure and presence of intubation-related complications.DESIGN: Double-blind, randomized trial.METHODS: A total of 139 adult surgical patients scheduled to undergo nitrous oxide-free general anesthesia were assigned into one of four groups according to the method used for ETTc inflation. The cuff pressure and air volume applied in each method, and laryngotracheal complications were recorded.FINDINGS: The highest and lowest ETTc pressure and air volume values were recorded in palpation and minimum leak technique group, respectively. Laryngotracheal complaints were maximized in palpation and minimized in minimal occlusive volume and minimum leak techniques.CONCLUSIONS: The air-return back into the syringe method emerges as an attractive and simple-to-perform alternative regarding effective ETTc sealing and low incidence of intubation-related morbidity when a cuff manometer is not readily available.STUDY REGISTRATION: ACTRN12615000699561.