Surgery Procedure Checklist Template
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Description
University of Minnesota Small animal procedure record (non-USDA species: rodents/frogs/birds) Date of procedure:_____________ Surgeon:_____________
AdCre Surgery #
Protocol Number:__ 1104A98432_______ Species/Group ID:__Mice_____________ Cage Bar Code:_____________________
Description of Procedure: Weigh mice, administer anesthetic, shave mouse, sterilize, place eye drops on eyes, make incision on back, pull fat pad of ovary out, inject virus into between bursa and ovary, place ovary back in body, close skin with staples, administer ketoprofen, place animal back in cage, change sterile tool pack at least every 6 mice, put 5ml’s children’s ibuprofen in water bottle, put red BSL-2(virus) monitor card in cage holder, put large red rubber band around cage for 3 days and monitor until back to normal behavior. Anesthetic Agent: Ketamine in combination with Xylazine, Acepromazine and 0.9% saline Master mix of Anesthetic and other drugs combined for amount of mice. From this mix we take the correlation amount by their weight. Mixture made for __ mice (___uL Ketamine, ___uL Xylazine, ___uL Acepromazine and ____uL Saline). Average mouse weight = ____g Route of Injection: Intraperitoneal cavity on ventral side Cage #
Animal ID
Animal Weight (g)
Dose 70mg/kg (mg)
Total Volume (uL)
AdCre / GFP (10uL)
Time anesthesia given
Time surgery start
Anesthetic depth assessed prior to procedure (toe pinch/corneal reflex) Heating device used to maintain body temperature Yes Ophthalmic ointment applied Yes
Time surgery end
Time anesthesia end
Yes
Group anesthesia start time:___________ Group surgery start time:______________ Intra-operative Monitoring Notes: Length of Individual surgery:_________________________________________ Assessments taken:
temperature
heart rate
respiration rate
anesthetic depth
BP
Frequency of assessments conducted within individual surgery: ___________________________________
Ketoprofen
Change sterile pack
Additional fluids, emergency agents (if applicable, including dose/route/time) and any complications and actions taken:
Group surgery completion time:_____________ Group anesthesia finish time:_______________ Group immediate post operative monitoring (including analgesic/antibiotic administration) Cage
Time
Comments
Time animals are sternal and fully recovered:_____________ Notes:
Initials
University of Minnesota Small animal post operative record (non-USDA species: rodents/frogs/birds) Cage Bar Codes:
Parameters to be assessed post surgically: date/time of monitoring, initials of person performing monitoring, analgesics/antibiotics given, including dosages and route, activity of the animals, eating/drinking status, urine and feces production, incision site observations (healing/infection/swelling/exudate/pain or dehiscence), coat texture and posture appearance (both indicators of pain) and procedure related complications. Post-operative records should be kept for a minimum of three days.
Day 1: Date:________________ Comments:
Time:_________________
Initials:______________
Day 2: Date:________________ Comments:
Time:__________________
Initials:______________
Day 3: Date:_________________ Comments:
Time:___________________
Initials:______________
Day 4: Date:________________ Comments:
Time:_________________
Initials:______________
Day 5: Date:________________ Comments:
Time:__________________
Initials:______________
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