Background:The pneumoperitoneum and surgical positioning in the laparoscopic surgery have been reported to result in an increase of airway pressure. However, associated effects on changes of endotracheal tube cuff pressure are not well established. Methods:110 patients were included in this study. In 55 patients, the laparoscopic surgery was performed in Trendelenberg position while in 55 patients the surgery was performed in reverse Trendelenberg position.Changes in endotracheal tube cuff pressure after pneumoperitoneum and surgical positioning were analysed and compared. Results:The endotracheal tube cuff pressure increased by approximately 5 cm of H2O after pneumoperitoneum in Trendelenberg position and by 2 cm of H2O in the endotracheal tube cuff pressure after pneumoperitoneum in reverse Trendelenberg position.After pneumoperitoneum the cuff pressure increased from 25 to 27.44 + 0.50 and 28.02 + 0.80 cm of H2O respectively for Trendelenberg and reverse Trendelenberg position. This difference was statistically significant in both the groups. There was a stastically significant increase in airway pressure from baseline after pneumoperitoneum in both groups however the difference was statistically not significant between the two groups with a p value > 0.05 using Fisher’s exact test.The incidence of post–operative tracheolaryngeal morbidity was significantly higher in Trendelenberg position group which correlated with higher cuff pressures Conclusions:The endotracheal tube cuff pressure gets affected by creation of pneumoperitoneum and patient position. There is significant increase in the endotracheal tube cuff pressure in laparoscopic surgery performed in Trendelenberg position