This article described the main theses of clinical guidelines of the Russian Federation of Anesthesiologists and Reanimatologists on postoperative pain management. The classification, etiology and pathogenesis of postoperative pain, the basic principles and algorithms for diagnosing pain, and the regional and systemic pharmacotherapy of pain in various fields of surgery are consistently presented. Multimodal analgesia is described in detail as a key concept of a current approach to the treatment of postoperative pain.

The Ministry of Health of the Russian Federation jointly with professional association and experts in the field of pediatrics, infectious diseases and resuscitation has revised guidelines “Clinical Features and Management of the Disease Caused by New Coronaviral Infection (COVID-19) in Children” in order to provide the child population with effective medical care during the pandemic of the new coronaviral infection. The practical experience of specialists from various countries was considered during the development of this document. Special attention should be given to the evidence base of the presented data, as well as to the efficiency and safety issues of medications used in treatment of coronaviral infection and its complications. The authors highlight the problems of prevention, diagnostics and management of pathological conditions caused by COVID-19 in the article according to the presented guidelines. Patient’s management is presented depending on the age and severity of the disease itself. The therapy is considered with regard to etiological, pathogenetic and symptom focus.

BackgroundGeneral anesthesia is required to perform pediatric cataract surgery. To reduce severity of surgical intervention and postoperative complications, regional techniques have been concomitantly used. The traditional regional ophthalmic techniques are retrobulbar, peribulbar and sub-Tenon blocks, which present some technical difficulties and associated complication risks. The pterygopalatine blockade has been exempt of many of these concerns as it is performed out of the orbit. The purpose of this study was to compare the analgesic and anti-inflammatory effects of the pterygopalatine blockade with retrobulbar block in children undergoing elective congenital cataract surgery.MethodsAfter approval of ethics committee and informed consents, patients were enrolled to the study to have either ultrasound-guided pterygopalatine block (group P) or retrobulbar block (group R), with 2 mL lidocaine 2% and 1 mL ropivacaine 0.5%. Hemodynamic monitoring was recorded throughout the perioperative period. Cortisol level and oxidation–reduction status were assessed before and after surgery. Pain and inflammatory response (Tyndall effect, corneal syndrome and edema) were assessed on the first postoperative day.ResultsComparative analysis demonstrated a decrease in cortisol of 123.24% (p˂0.05) and an increase in the redox coefficient of 37.7% (p˂0.05) in group P. Pain intensity was significantly higher in group R until the 16th postoperative hour. The corneal syndrome in patients in group P and group R was noted by 7.6% and in 32.1%, respectively (p˂0.05).ConclusionThe use of the pterygopalatine blockade as a component of anesthesia in pediatric cataract surgery allows reduction of the severity of surgical stress during surgical intervention, providing intraoperative hemodynamic stability and prolonged analgesia.

В статье представлен проект клинических ре-комендаций по оказанию реанимационной помощи детям, нуждающимся в межгоспиталь-ной транспортировке, разработанный с учетом территориальных особенностей Российской Федерации. Детально рассмотрены правовые аспекты организации службы межгоспитальной транспортировки, возможные побочные эффек-ты транспортировки, дана характеристика авиа-ционного и наземного санитарного транспорта, отражены его основные достоинства и недостат-ки. Предложена оценка риска транспортировки, выраженная в рангах, соответствующих продол-жительности безопасного времени транспорти-ровки. Приведены оригинальные шкалы оценки риска транспортировки, основанные на необхо-димости проведения экстренной регидратации, инотропной и вазопрессорной терапии, а также респираторной поддержки. Особое внимание уделено подготовке детей в критическом со-стоянии к межгоспитальной транспортировке, изложен детальный протокол мероприятий интенсивной терапии, мониторинга и ухода на этапе транспортировки. Описаны целевые пока-затели стабилизации состояния пациента в бли-жайшие шесть часов после транспортировки. Использование представленных ключевых принципов безопасной транспортировки по-зволит существенно повысить качество оказа-ния медицинской помощи детям, нуждающимся в переводе в специализированные стационары.Ключевые слова: межгоспитальная транспор-тировка, дети, критическое состояние, риск, ин-тенсивная терапия Для цитирования: Шмаков АН, Александро-вич ЮС, Пшениснов КВ, Заболотский ДВ, Разумов СА. Оказание реанимационной помощи детям, нуждающимся в межгоспитальной транс-портировке (проект клинических рекомендаций). Альманах клинической медицины. 2018;46(2):94-108.