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There is increasing use of a new technique-percutaneous tracheostomy-by intensive care specialists. In this procedure tracheostomy is performed by making a small incision in the skin and creating a tunnel in the tissues, which is gradually enlarged by dilation. The trachea is punctured blindly and the tunnel, or tract, is dilated until a tube can be passed over an introducer into the trachea itself. Special instrument sets are manufactured for percutaneous tracheostomy, and it is a satisfactory procedure in experienced hands. It is usually undertaken in the intensive care unit using local anaesthetic. Most candidates are in fact already sedated and being ventilated.