ANESTHESIA RECORD and

SURGERY REPORT, continued

/ Research Animal Resources Center
University of Wisconsin-Madison
Madison, WI 53726
Species: Animal ID______Date: ______Weight______Protocol# Procedure:______Surgeon:______Assistant:______
Anesthetist: ______Animal Fasted: □ Yes □ No
Remarks: ______

Premed, Induction, Anesthetic & Analgesic Drugs

Time / Drug / Lot#/Vial ID & Expiration Date / Dose (total, recorded in mg) / Route / Initials

Maintenance

Endotracheal tube size: ______

Gas Anesthesia no yes ® Isoflurane Sevoflurane Start time:______

Extubation time:______

Respiration spontaneous rebreathing/non-rebreath(time) ______ventilator (time)______

Procedure start time:______Procedure end time:______

Monitoring

Observations should be recorded from the time that the animal is stable after induction until the animal is recovered and placed back in their cage. Recovery is defined as when the following conditions are met: 1) the animal is physiologically stable, 2) analgesia is assured, and 3) the animal can lift its head and remain sternal.

% Gas = anesthetic vaporizer setting HR = heart rate RR = respiratory rate Temp = body temp

Fluids = please record cumulative total and specify the type (0.9% saline, lactated ringers, etc.)

Time / % Gas / Fluids / HR/RR / SPO2 / ETCO2 / Surgical Events/Other Comments/
Additional Drugs / Initials /

Description of Surgical Procedure and Findings

The surgical description minimally includes the surgical procedure, the approach taken, type of suture used, type of implant used (if applicable) and the surgeon’s closure technique. A template using the description of the surgery from the approved animal protocol can be used. Please provide description below or attach separate sheet.

Surgeon(s) signature or initials:______

Time / % Gas / Fluids / HR/RR / SPO2 / ETCO2 / Surgical Events/Other Comments/
Additional Drugs / Initials /

July 2017

RARC Veterinary Staff

July, 2015 Page ____ of ____