Tracheal extubation is a critical step in general anesthesia. Accidents during extubation often result in serious consequences such as hypoxic brain injury or death. With the update of various advanced extubation tools and algorithms, the extubation programs have become more diverse and complete. However, until now, there is still no single absolute reliable prediction method and extubation strategy that can be applied to all difficult tracheal extubation. The anesthesiologist still needs to comprehensively and carefully evaluate the patient and follow the program of individualized extubation. This review summarizes the predictive factors of difficult tracheal extubation and the research progress of extubation strategies in recent years, including airway assessment, evaluation of high‑risk extubation, and evaluation of other tools and methods to predict difficult extubation. Meanwhile, we introduce relevant extubation algorithms and various extubation tools, drugs, etc.