In this editorial, @dr_imranahmad & @doctimcook consider the PUMA tracheal extubation guidelines and ask - towards clarity or complexity? "Should we continue to develop guidelines tailored to specific clinical scenarios, considering factors such as location, speciality and patient characteristics? Or is it possible for a single, universal guideline to be applied globally, like the PUMA group envisages?" #anaesthesia @NicholasChrimes @UniversalAirway doi.org/10.1111/anae.70436