Awake tracheotomy is a method that can be used to preserve spontaneous breathing while under local anesthetic. Typical indications include stenotic tumors of the larynx and hypopharynx. 6.7% of patients report cough as a problem due to the tube. Patients who are considered candidates for an awake tracheotomy should have a well-trained team available, including a anesthesiologist experienced in airway management, a surgeon skilled in tracheal surgery, a critical care nurse experienced in managing patients undergoing this procedure, and a respiratory therapist knowledgeable about mechanical ventilation settings appropriate for this patient population. The patient is given general anesthesia, during which time a small incision is made in the neck below the collarbone. The trachea is exposed by lifting up the skin and lining of the chest cavity. The trachea is then separated from its cartilage rings. This allows the surgeon to see and work on the airway without obstruction from the jaw or tongue. The vocal cords next to the opening in the trachea are usually removed (laryngoscopy is performed to verify correct position). After removal of the vocal cords, the opening in the trachea is closed using several layers of sutures.