Evaluation of Optimal Tracheal Tube Cuff Pressure Using Stethoscope-Guided Inflation and Expired-to-Inspired Tidal Volume Ratio Technique in Pediatric Patients Aged 2-7 Years: A Prospective Randomized Controlled Trial

Endotracheal intubation in pediatric anesthesia requires careful management of the endotracheal tube (ETT) cuff pressure to ensure an adequate airway seal while minimizing the risk of tracheal mucosal injury. Unlike adults, children have a more delicate airway mucosa with lower mucosal capillary perfusion pressure, rendering them especially susceptible to ischemic damage from excessive cuff pressures. Maintaining ETT cuff pressures below 20 cm H2O is widely recommended in pediatrics to balance effective ventilation against the risk of mucosal injury and subsequent postoperative airway complications such as cough, sore throat, and subglottic edema. This study hypothesizes that the expired-to-inspired tidal volume ratio technique will yield superior outcomes in achieving optimal cuff pressures with a lower incidence of post-extubation cough compared to the stethoscope-guided inflation method in pediatric patients aged 2 to 7 years.