Background The extubation failure of difficult airway is relatively high， and often result in serious complications. Objective It is very important to fully examine the airway and formulate safe but reversible extubation strategies before extubation. Content This review will focus on the evaluation before the extubation and the strategies for extubation of a known or suspected difficult airway. Trend For a patient with difficult airway, sufficient and thoroughly airway evaluation is very necessary before extubation. One should familiar with the algorithms of intubation and extubation of a difficult airway, and familiar with the techniques of airway exchange catheter and other auxiliary tool for extubation of a patient with difficult airway.