Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 02 17 1520 1520 Pragya Pragya Department of Anaesthesiology,Chacha Nehru Bal Chikitsalaya, Children’s Hospital, Delhi, India. Shilpa Agarwal Department of Anaesthesiology,Chacha Nehru Bal Chikitsalaya, Children’s Hospital, Delhi, India. Geeta Kamal Department of Anaesthesiology,Chacha Nehru Bal Chikitsalaya, Children’s Hospital, Delhi, India. Charu Charu Department of Anaesthesiology,Chacha Nehru Bal Chikitsalaya, Children’s Hospital, Delhi, India. Neha Jain Department of Anaesthesiology,Chacha Nehru Bal Chikitsalaya, Children’s Hospital, Delhi, India. Aikta Gupta Department of Anaesthesiology,Chacha Nehru Bal Chikitsalaya, Children’s Hospital, Delhi, India. 2025 12 11 2025 12 20 Background: Optimal sizing of endotracheal tubes (ETTs) in pediatric patients may lead to repeated laryngoscopies, intubations, and ETT exchanges. The subglottis is functionally the narrowest part of the pediatric airway and is prone to edema, tracheal lumen narrowing, and post-extubation stridor due to repeated airway manipulations. Objectives: To compare the proportion of infants up to 3 months of age who require ETT exchanges and who develop postoperative respiratory adverse events (PRAEs) following intubation with Microcuff versus uncuffed ETTs. Methods: This prospective randomized study included 100 patients up to 3 months of age. They were randomized into two groups of 50 each: Gp M: intubated with microcuff ETT. Gp U: intubated with uncuffed ETT. A leak test was done after intubation. In Gp U, excessive leak at 10 cm of water pressure required a 0.5-size bigger ETT. A minimal leak at 10-20 cm of water was acceptable. No leak at 20 cm of water required downsizing ETT by 0.5. In Gp M, the cuff was inflated until minimal leak at 10-20 cm of water. No leak with the deflated cuff at 20 cm of water warranted exchange with an uncuffed ETT of size 3.0. Results: In Gp U, 12/50 (24%) patients underwent tube exchanges, and 6/50 (12%) had post-extubation stridor. In group M, 4/50 (8%) patients required tube exchange to size 3.0 uncuffed ETT, and one patient (2%) had post-extubation stridor. Conclusion: Microcuff ETTs have a lesser incidence of tube exchange and post-extubation stridor as compared to uncuffed ETTs in infants up to three months of age. https://aacc.tums.ac.ir/index.php/aacc/article/view/1520