Effect of Continuous and Slow Endotracheal Tube Cuff Deflation on Post-Extubation Laryngospasm: A Review

Background: Laryngospasm is a critical complication during emergence from general anaesthesia, frequently triggered by airway manipulation and abrupt mechanical stimulation. Conventional rapid endotracheal tube (ETT) cuff deflation may provoke intense tracheal irritation, increasing the risk of airway reflex activation. Slow and continuous cuff deflation has been proposed as a gentler technique that may minimize mucosal stimulation and prevent post-extubation laryngospasm. Aim: To summarize current evidence regarding the physiological basis and clinical impact of slow ETT cuff deflation, and to evaluate its potential role in reducing post-extubation laryngospasm. Methods: Narrative review of available randomized trials, observational studies, and physiological literature on ETT cuff mechanics, airway reflexes, extubation complications, and laryngospasm. Results: Existing randomized clinical trials demonstrate that slow cuff deflation reduces cough incidence, hemodynamic surges, and pharyngolaryngeal irritation compared with rapid deflation. While studies directly assessing laryngospasm are limited, mechanistic evidence suggests that gradual reduction of cuff pressure decreases abrupt mucosal stimulation, reduces activation of rapidly adapting airway receptors, and may lower laryngospasm risk. Clinical practice reports indicate smoother extubation and fewer transient airway complications with slow cuff deflation. Conclusion: Continuous and slow ETT cuff deflation is a simple, physiologically rational, and effective technique to reduce airway stimulation during extubation. Although direct evidence for laryngospasm prevention is limited, existing data strongly support potential benefit. Larger randomized clinical trials with laryngospasm as the primary endpoint are needed.