Background: Endotracheal tube cuff (ETTc) inflation pressure is usually not regarded as an important aspect during intubation. In this study, we compared measuring ETTc pressure and pilot balloon palpation method in causing post-operative airway complications. Methods: Two hundred and ninety-two surgical patients requiring intubation were recruited into this prospective, double-blind, randomised controlled study. Group A patients had their ETTc initially inflated, checked by a cuff pressure gauge, recorded and then set to 25 cmH2O. Group B patients had their ETTc inflated using the pilot balloon palpation method. Patients were then followed up for post-operative sore throat, hoarseness and cough. Results: The overall incidence of post-operative sore throat was 39.0% versus 75.3% (P < 0.001), hoarseness 6.2% versus 15.1% (P < 0.05) and cough 7.5% versus 21.9% (P < 0.05) in Group A and B, respectively. Group A patients experienced a significant reduction in the incidence and severity of sore throat up to 24 h post-operatively (P < 0.001), hoarseness at the first hour (P = 0.004) and cough at first and 12 h post-operatively (P = 0.002). Conclusion: Adjusting the ETTc pressure to 25 cmH2O reduces post-operative sore throat, hoarseness and cough compared to pilot balloon palpation method.