A Near Tragedy

After a long week in the operating room, you are relaxing on a beach south of Durban in South Africa. The weather is wonderful. Just behind the beach is a lagoon. When the tide is coming in, the Indian Ocean enters the lagoon at the end of the beach where there are many rocks. Suddenly, there is a cry for help, and you rush to the rocks to see a 6-yr-old boy in the water to his armpits with the tide coming in. He is screaming that he cannot get his foot out. Two men are both busy trying to release his foot. It will not come out. Over 200 people are now gathered around. You introduce yourself, offer help, as an anesthesiologist, to the two men, and discover that one is an orthopedic surgeon and the other a cardiac surgeon. They say they may need your help, as in less than 10–15 minutes the water will be over the boy’s head and in that case, they will need to amputate the foot. You run to your car. In the boot, you have all the anesthetic drugs and equipment (including a draw- over vaporizer) you will need to anesthetize the child. You consider sedating the child with the drugs you have in your bag, namely meperidine, fentanyl, or morphine but are concerned they may not suffice in preventing pain and you may also loose the airway. The other option is a general anesthesia with propofol, succinylcholine, an endotracheal tube, and a draw-over vaporizer. Is there any other drug or technique you would consider?