A 550-lb patient is recovering in the postoperative care unit after a laparoscopic cholecystectomy..

A 550-lb patient is recovering in the postoperative care
unit after a laparoscopic cholecystectomy. The procedure was uneventful. The
nurse called you because the SpO2 decreased from 95% to 88% over the
past hour despite a nonrebreather facemask at 12 L/min. You see the patient;
she is calm, resting in no pain, and breathing regularly at 8 breaths/ min.
Other vital signs are heart rate 66 beats/min, blood pressure 128/70 mm Hg and
body temperature 36.5°C. After reviewing the nursing notes, you notice that patient
required 4 mg of midazolam before surgery for anxiety, 4 mg of hydromorphone
during surgery, and additionally 10 mg of morphine in the recovery room.

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