The majority of immediate complications of tracheostomy incurred were often due to hurried performance of tracheostomy under inadequate emergency conditions, with poor definition of anatomic landmarks. These complications have largely disappeared.14 Hypoxia, which occurs during an urgent performance of tracheostomy and is sometimes accompanied by cardiac arrest, is eliminated when the procedure is done under elective conditions after establishment of an adequate airway. Laceration of the membranous tracheal wall can occur as a result of excessively forceful insertion of an inappropriate tube. The procedure of tracheostomy itself nowadays almost always follows establishment of an airway. A rare exception may be necessary, in separation of the cervical trachea following blunt trauma, where emergency bronchoscopy fails to reveal a channel to the distal trachea (see Chapter 9, "Tracheal and Bronchial Trauma"). In such a case, preparation is always made prior to endoscopy for emergent tracheostomy. Operative damage to structures such as the recurrent laryngeal nerves, the great vessels of the neck, and the esophagus has been

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