SummaryBackgroundAn intracuff pressure of 80 cm H2O in the adult‐sized laryngeal mask airway Supreme has been recommended to obtain a higher oropharyngeal leak pressure (OLP). However, the intracuff pressure for the higher OLP in the pediatric laryngeal mask airway Supreme could be different from that in the adult‐sized laryngeal mask airway Supreme. Thus, we measured and compared OLP at three intracuff pressures of 40, 60, and 80 cm H2O in the pediatric laryngeal mask airway Supreme.MethodsThis study was designed as a randomized crossover study and enrolled 36 children, aged 0–108 months and 5–30 kg in weight. After insertion of the laryngeal mask airway Supreme, oropharyngeal leak pressure (OLP) was measured at intracuff pressures of 40, 60, and 80 cm H2O according to one of six sequences produced on the basis of 3 × 6 Williams crossover design. During the intraoperative period, the laryngeal mask airway Supreme was maintained using the last intracuff pressure of the allocated sequence. The intraoperative and postoperative complications were compared among three maintenance intracuff pressures.ResultsOLP at the intracuff pressure of 60 cm H2O was significantly higher than that of 40 cm H2O (17.9 ± 3.9 vs 16.9 ± 4.2 cm H2O, P = 0.004) and was comparable with that of 80 cm H2O (17.9 ± 3.9 vs 17.8 ± 4.6 cm H2O, P = 0.938). There were no significant differences of intraoperative and postoperative complications among the three maintenance intracuff pressures.ConclusionOur results suggest that the use of an intracuff pressure of 60 cm H2O in pediatric laryngeal mask airway Supreme provides a higher OLP compared with 40 cm H2O.