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Tracheostomy is a common artificial airway in the operative room (OR) or intensive care units for maintaining airway patency. Patients with tracheostomy are generally considered with a “secure” airway and would be preoxygenated before anesthesia induction. However, there are some pitfalls for an anesthesiologist when confronting with tracheostomy management. As a crucial component for ventilation, any management of tracheostomy should be conducted prudently. We report a case with tracheostomy presented to OR with loss of capnography but fair oxygen saturation which proved to be tube dislodgement by fiber-optic bronchoscopy timely without further desaturation.