To determine the effects of cardiopulmonary bypass (CPB) on tracheal cuff pressure, we have measured intracuff pressure (ICP) in 29 consecutive patients undergoing cardiac surgery with CPB. Premedication comprised hyoscine and, after induction of anaesthesia with diazepam and fentanyl, followed by vecuronium, the trachea was intubated using a Portex Profile tracheal tube. Anaesthesia was maintained with high-dose fentanyl and 100% oxygen. ICP was measured with a transducer and the ICP was adjusted to 20 mm Hg. CPB was used with mild to deep hypothermia and blood-gas tensions were regulated according to alpha-stat (temperature uncorrected) pH management. Before CPB, ICP was significantly reduced from the mean baseline value of 20 (SEM 0.2) to 16.7 (0.6) mm Hg (P < 0.01). ICP changed significantly during CPB, decreasing to 8.0 (1.0) mm Hg before rewarming (P < 0.01 vs immediately before CPB) and increasing to 17.0 (0.6) mm Hg after the start of rewarming (P < 0.01 vs before rewarming). After CPB, ICP did not differ significantly from that immediately before CPB. We conclude that the decrease in ICP during the hypothermic phase of CPB may protect the tracheal mucosa against hypotensive ischaemic injury.