This patient should keep the head of his bed elevated at 30 degrees. He is at high risk for obstructive sleep apnea (OSA) as evidenced by his STOP-BANG score of 6 (snoring, observed apneic episodes, hypertension, BMI >35, age >50 years, and male gender). Patients with a STOP-BANG score greater than or equal to 5 have an increased risk for severe OSA and postoperative morbidity. Conservative postoperative measures that may reduce the risk of pulmonary complications from suspected OSA include nonsupine positioning (keeping the head of the bed at 30 degrees), careful use of sedatives and opioids, and continuous pulse oximetry.

Nasogastric intubation is not appropriate in this patient because it is not known to alter risk of complications from possible OSA postoperatively. Nasogastric tubes are associated with an increased risk of aspiration and pneumonia. Good evidence supports the selective use of nasogastric intubation for the same indications as in the nonoperative setting (for example, severe gastric distention and intractable large-volume emesis).

The patient has no wheezing, dyspnea, or other evidence of small airway obstruction. Therefore, he has no indication for the use of albuterol.

Continuous positive airway pressure (CPAP) ventilation is not indicated at this time. The patient is alert, breathing comfortably, and oxygenating well. Furthermore, his pain is well controlled, so he will not require high doses of systemic opioids. The American Society of Anesthesiology recommends only initiating CPAP for patients at risk for OSA who develop hypoxia or apneic episodes. At least one study has suggested that empiric use of CPAP for all patients at risk for OSA did not improve outcomes and increased length of hospital stay.