Case Presentation: 75-year-old female with past medical history of obesity (BMI 31.7 kg/m2), paroxysmal atrial fibrillation, hypertension, hypothyroidism, was admitted to the hospital for elective laparoscopic cholecystectomy. Patient tolerated the procedure without complications, however, post operatively, she was difficult to extubate due to hypercapnia of pCO2 of 100 mmHg in arterial blood gas. She was [...]