Objectives: To assess the clinical performance of the laryngeal mask airway-Supreme in children. Aim: The purpose of this prospective audit was to evaluate the feasibility of the laryngeal mask airway-Supreme in clinical practice and generate data for future comparison trials. Background: The laryngeal mask airway-Supreme is a new second-generation supraglottic airway that was recently released in limited pediatric sizes (sizes 1, 2). Methods: One hundred children, ASA I-III, newborn to 16 years of age, and undergoing various procedures requiring a size 1, 2, or 3 laryngeal mask airway-Supreme were studied. Assessments included insertion success rates, airway leak pressures, success of gastric tube insertion, quality of airway, and perioperative complications. Results: The first-time insertion success rate was 97%, with an overall insertion success rate of 100%. The mean initial airway leak pressure for all patients was 22.3 +/- 6.6 cm H(2) O. Gastric tube placement was possible in 98% of patients. Complications were noted in six patients: coughing or laryngospasm (n = 3), sore throat (n = 1), and dysphonia (n = 2). Conclusions: The laryngeal mask airway-Supreme was inserted with a high degree of success on the first attempt by clinicians with limited prior experience with the device. It was effectively used for a variety of procedures in children undergoing spontaneous and mechanical ventilation with minimal complications. The leak pressures demonstrated in this study, along with access for gastric decompression, suggest that the laryngeal mask airway-Supreme may be an effective device for positive pressure ventilation in children.