In recent years, the indications for emergency tracheostomy are declining, however, elective tracheotomies are still performed in certain clinical conditions especially those requiring long term – assisted ventilation. This life saving procedure is now rarely performed. So many young residents find it a serious challenge when first confronted with the necessity to perform one, especially under emergency situations. This article aims at elucidating practical and clinical aspects of management of patients with tracheostomy. Keywords: tracheostomy, complications, management Annals of Nigerian Medicine Vol. 1(2) 2005: 6-