A 54-year-old male is scheduled for a left knee arthroscopy for anterior cruciate ligament (ACL) reconstruction at an ambulatory center. The patient reports that a tooth was dislodged during a previous cholecystectomy. The patient has a past medical history significant for severe obstructive sleep apnea (OSA), where his previous sleep study indicated an apnea–hypopnea index (AHI) of 65 events per hour, minimum oxygen saturation 65% and mean oxygen saturation of 80%, and the patient spent 30% of total sleep time below oxygen saturation of 90%. The sleep study was done two years ago, and he gained some more weight due to the knee injury and limited physical activity. While he was advised to use positive airway pressure therapy, details of the machine settings were not known as he stopped using the machine a few months after the second therapeutic sleep study. He continues to snore loudly, his wife has observed him to have multiple “breathing stops” while asleep, he uses the bathroom 4–5 times per night, and is always found to be “sleepy” during the day. The patient has hypertension that is well controlled on a β-blocker and an ACE inhibitor. He has a blood pressure of 155/84 mm Hg, heart rate of 105, respiratory rate of 20, neck circumference of 45 cm, a temperature of 35.6 °C and current BMI of 48 kg/m2. His hematocrit is 49% and serum bicarbonate is 30 mmol/L. Is this patient a candidate for an outpatient surgery? How would you induce anesthesia? Would you prefer to do a regional or general anesthetic? Are you concerned that he is a difficult intubation? How would you manage his post-operative pain? Will he need special post-operative monitoring?