tracheostomy is a relatively common hospital procedure that can be performed surgically via an open approach or a percutaneous approach. Furthermore, these procedures can be done with the patient awake often with the aid of local anesthetics, nerve blocks, and sedation or it can be done with the patient fully asleep via general anesthesia. General anesthesia is typically used if upper airway anatomy allows for vocal cord visualization and endotracheal tube insertion. An awake approach with local anesthesia is typically used if anatomical abnormalities, such as laryngotracheal dislocations and supraglottic masses, interfere with oral access or ability to ventilate the patient. Options for local anesthesia include topic anesthetic ointment, transtracheal injection, and nerve blocks [1]. Nerves to consider targeting with the block include the glossopharyngeal, superior laryngeal, recurrent laryngeal nerve, sphenopalatine, and anterior ethmoidal nerves.