Two reports concerning difficulties at insertion of a minitracheostomy cannula are presented. In one patient, a minitracheostomy tube perforated the posterior wall of the trachea, resulting in pneumomediastinum. In another patient, conventional signs, i.e. airflow and passing of a suction catheter through the cannula, were misleading in assessing the position of the tube. Fiberoptic tracheoscopy immediately after the performance of minitracheostomy revealed the position of the cannula in both cases.