Inclusion Criteria:  Age 18 years of age or older Patients undergoing procedural deep sedation American Society of Anesthesiology (ASA) Physical Status I-III BMI ≥30 kg/m2 or documented Obstructive Sleep Apnea Has provided written informed consent Difficult airway  Exclusion Criteria:  Acute exacerbation of respiratory disorders, including COPD and asthma Emergent procedures Pregnancy Previous enrollment in this study Inability to provide informed consent History of allergic reaction to Propofol Tracheostomy Exclusion criteria: deep sedation procedures that require intra-oral instrumentation (ie: EGD, transesophageal echocardiography