Description of Proposed Surgical Procedures

Appendix A

PI Name:

Project Title:

DESCRIPTION OF PROPOSED SURGICAL PROCEDURES

Important: Complete a separate Appendix A for each animal species.

1. Species:

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1. Surgical procedure is: Non-survival Survival

(For multiple survival surgeries, an Appendix A is needed each time the animal is anesthetized.)

1. Location of surgical procedure: Building Room

1. Name each individual performing the surgery and relevant training/experience (include number of years) with the animal species and surgical procedures being used.

1. Describe the pre-anesthetic and anesthetic procedures to be used. Indicate below the dose, route, and frequency of administration of all tranquilizers, analgesics, and anesthetics to be used before and during surgery.

5a.Describe any special requirements such as pre-surgical withdrawal/restriction of food and water.

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6.Will paralytic drugs be used? Yes No-go to question #7

6a.If yes, fill in the table below and answer questions 6b and 6c:

6b.How will the absence of pain be assessed?

6c.How will ventilation be maintained?

7.How will anesthetic depth be monitored during the procedure? Select all that apply.

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respiratory rate heart rate

pedal reflex (toe pinch)  tail pinch

corneal reflexmuscular relaxation

color of mucous membranesother (pulse oximeter, respirometer)

8.Describe how the animal will be prepped for surgery.

9.Describe the complete surgical procedure.

FOR NON-SURVIVAL SURGERY complete # 10

10.Describe how the animal(s) will be euthanized.

FOR SURVIVAL SURGERY, continue with #s 11 and 12.

Important: Aseptic technique must be used on ALL animals.

1. Describe the following:

11a.Method for instrument sterilization:

11b.Postoperative analgesia:

11c.Postoperative monitoring and care (Note: You are required to keep accurate records of postoperative monitoring and care of all animals/group of animals, including rodents. This information may be requested during inspection of surgical facilities.):

11d.Personnel who will provide the monitoring and care:

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1. Indicate criteria for assessing the level of postoperative pain, distress, and/or discomfort. Select all that apply.

loss of appetite failure to groom/unkempt appearance

labored breathing abnormal resting posture

weight lossguarding/protecting the painful area

vocalizationloss of mobility

self-mutilation

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