In an earlier paper Burn & Froede (1963) described the action exerted on post-ganglionic sympathetic fibres by phenyltrimethylammonium. They showed that this substance, like bretylium, blocked the response to stimulation according to the frequency used, and that stimulation at high frequencies was blocked earlier than stimulation at low frequencies. This indicated that the action was not that of a local anaesthetic. They chose phenyltrimethylammonium because Riker (1953) had shown that it had a curare-like action at the neuromuscular junction, and it was therefore well suited to test the view that substances which blocked the action of acetylcholine at the neuromuscular junction would also block the release of noradrenaline by impulses passing along the sympathetic post-ganglionic fibres. This view was based on the hypothesis of Burn & Rand (1959) that the sympathetic impulse first released acetylcholine, and this in turn released noradrenaline.Dixit, Gulati & Gokhale (1961) showed that both bretylium and guanethidine blocked the response of the rat diaphragm to stimulation of the phrenic nerve without affecting the response to direct stimulation of the diaphragm. They compared these substances with decamethonium and D-tubocurarine. The significance of their results has been criticized on the ground that the concentrations of bretylium and of guanethidine needed to block the phrenic nerve-diaphragm preparation were high, and that a feeble action was of no significance. We have therefore repeated the observations of Dixit et al. on bretylium and guanethidine, and we have also examined the action of mecamylamine on the phrenic nerve-diaphragm. Recently Burn & Gibbons (1964a) showed that mecamylamine exerted a blocking action in the sympathetic post-ganglionic fibre. We have also tested the action of D-tubocurarine, dihydro-,8-erythroidine, tetraethylammonium and decamethonium on the sympathetic postganglionic fibre.
A primary concern in healthcare today is the prevention of infection. Surgical site infections (SSIs) are the leading type of infection among hospitalized patients. Advanced practice nurses play a vital role in patient care, and those who incorporate best practice standards can reduce the morbidity and mortality associated with SSIs. The Centers for Disease Control and Prevention have published recommendations for prevention of SSIs. This article reviews current literature regarding the prevention of SSIs and how critical care practitioners can incorporate these scientifically tested recommendations into their practice.
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