North Carolina Stateuniversity Iacucguideline
North Carolina StateUniversity IACUCGuideline
(Approved August 21, 2014)
Intra-andPostoperativeMonitoring andRequiredRecordKeepingfor Surgery andAnesthesia
Regulatory guidelines and standardsofadequateveterinarycare impose certain requirements for intraoperative monitoringand postoperative careforresearch animals, and forthemaintenance of appropriate medicalrecords. Theseresponsibilitiesarethe PrincipalInvestigator's. However, each NCSU animalresource unithasanattending veterinarian whoshould beconsulted, duringthe planningstage for experimentalsurgicalprocedures, aboutthe provision ofappropriate perioperativecare.Assistance with experimentalsurgery, anesthesia, andpostoperative care isavailable fromCVM LaboratoryAnimal Resources(Clinical Veterinarian: Dr. C. Tyler Long919-513-2365 ;Attending Veterinarian:Dr. Gabriel McKeon 919-513-6638 )or through the CVMCentralProcedures Laboratory(919- 513-6486 ).
Individualwritten records ofanesthesia/surgery/postoperative recoverymustbe maintainedforall non-rodentmammals thatundergo recoveryanesthesiaORsurgicalprocedures. (Informationaboutrodents and non-mammalian vertebratesis below.)Therecordmustbe kept intheroomwheretheanimalis housed,ornearby, and mustbe accessible bythe attending veterinarian.Recordsshould beretained as a partoftheanimal’s permanentmedicalrecord. Formatforrecordsisflexible, aslongas required elements (below)are documentedand clear;forms are availablefromCVM LaboratoryAnimalResources (Clinical Veterinarian: Dr. C. Tyler Long919-513-2365 ;Attending Veterinarian: Dr. Gabriel McKeon919-513-6638 )orthrough the CVM CentralProcedures Laboratory(919-513-6486 or ).
Thereareno requirements formedicalrecord keepingin non-survival(terminal)procedures. However, fromthe standpointofboththe animal’s welfare and the successoftheexperiment, intraoperative monitoringmaybe justas importantin terminalexperiments as in recoveryprocedures(see following section). Fornon-survivalprocedures, PIs are encouraged to keeprecords thatdocument theiruse of anesthetic, analgesic, andtranquilizingagents, andtheir intraoperative monitoringprocedures.
Intraoperative Monitoringand RecordKeeping– Non-rodentMammals
Intraoperative monitoring of the animal's state ofhomeostasis andanesthesia isnecessary, and maintainingan intraoperative recordmaybe importantto enhance recognition oftrendsin monitored variables.The typesandfrequencyofmonitoringwillvarywith boththespecies and thenature/length of the anesthesia/surgery;monitoringshouldassesscirculation (e.g., heartrate andcharacter (pulse pressure), ECG, blood pressure);oxygenation(e.g., mucous membrane color,pulseoximetry);ventilation(e.g., respiratoryrate and character, capnography);and bodytemperature. (See suggestions bythe American College of VeterinaryAnesthesiologists: “SmallAnimalMonitoringGuidelines”).
Recoverysurgery/anesthesia records must include at leastthefollowing:
•Date ofprocedure
•Animal identification
•Surgeon and PIname(s)
•Briefdescriptionoftheprocedure
•Time ofanesthetic induction and termination
•Alldrugs administered, includingdose,time, androuteofadministration
In addition,recoverysurgery/anesthesiarecords must include documentation ofmonitoringappropriate to the procedure:
•Ata minimum(e.g., forminorand minimallyinvasive surgeries), temperature andheartand respiratoryrates should be recordedimmediatelybefore and atthe conclusion ofthe procedure.
•For invasive procedureslastingmore than30 minutes,results ofintraoperative monitoring(minimally,
heartrate, respiratoryrate,bodytemperature and depth of anesthesia)should be recorded every15 minutes.
Postoperative/Postanesthetic Monitoringand RecordKeeping– Recovery Period
Immediatelyfollowingsurgery/anesthesia, animals should beplacedin aclean, quietenvironmentwhere theycan be observed closelybyappropriatelytrained personnel while theyrecoverfromanesthesia. Animals recoveringfromanesthesia mustbecloselyattended, atleastuntiltheyregain therightingreflex (abilityto maintainsternalrecumbency). Allfoodandwaterbowlsandanyotherphysicalhazards should be removed fromthe cage/pen where the animal isrecoveringfromanesthesia.Monitoringof the animal mustcontinueatappropriate intervals (as described in the IACUC-approved animal use protocol)throughoutthe postoperative period, whichextends untilthe removalofsutures andtheobservationthatincisions are essentiallyhealed.
Thepostoperative/postanestheticrecordshould beattachedto the surgery/anesthesiarecordand must includethefindings, with date/time and initials orsignature ofperson performingthe examination, of each physicalexaminationduringthe postoperative period. Non-rodentmammals should be examined and records kept accordingtothe followingschedule:
A.Animalunconscious orsemi-conscious;unable tositormaintainsternalrecumbency.*
1.Animals should bemonitored continuouslyuntilextubated,oruntilthereis astrong swallowingreflex.
2.Thereafter,examinethe animalnot lessthanhourly. Monitoringshouldinclude:
•bodytemperature
•heartrateand pulse character
•respiratoryrate andcharacter
•mucous membrane colorand capillaryrefill time
•additionalmethods as necessarytoidentifypotentialpostoperative problems and ensure uneventfulrecovery
3.Recumbentanimals shouldbe turnedfromside tosideapproximately every 15 minutesto preventdependent pulmonarycongestion, edemaand muscle damage.
4.Ambienttemperature should be adjusted accordingly(circulatingwaterpad,heatlamp orwarming board)to maintain normalbodytemperature.The animalshould be keptdry.
5.Thestate ofhydration should beassessed andfluids provided as necessary.
6.Analgesicadministration should dependon the surgical/anesthesiaplan and be outlined within the protocol.
7.Themedicalrecordduringthisperiodmustdocumentatleastthefollowing:
•Extubation ofthe animal, ifapplicable
•Results ofmonitoring(minimally:bodytemperature, heartrate,respiratoryrateand level of sedation)
•Anyclinicalabnormalities
•Alltreatments provided(includingdrugdosage androute ofadministration)
B.Animalconsciousandcanmaintainsternalrecumbencyorsitupright butcannotstand.*
1.Examine theanimalnotless than every6 hours dependingon the nature ofthesurgery and the status of the animal. Monitoringshouldinclude:
•bodytemperature(until itapproaches pre-anesthetic level+/-2 degrees F)
•heartrateand pulse character
•respiratoryrate andcharacter
•mucous membrane colorand capillaryrefill time
•appearance ofthe incisionsite (if present)
2.Examine closelyforother abnormalities (incision site, bandages, mentation)
3.Keep the animaldryand adjust the ambienttemperature to bringthe bodytemperatureto normal.
4.Administeranalgesics based on the surgical/anesthesiaplanand/orindications ofpain.
5.Themedicalrecordduringthisperiodmustdocumentatleastthefollowing:
•Returntoconsciousness orabilityto maintain sternalrecumbency
•Results ofmonitoring(minimally:bodytemperature)
•Anyclinicalabnormalities
•Alltreatments provided(includingdrug, dosage androute ofadministration)
C.Animalcan standand move about; butnoteatingand drinkingnormally.*
1.Examine animal twicedaily. Monitoringshouldinclude:
•bodytemperature
•mucous membrane colorand capillaryrefill time
•hydration
•attitude and activity
•food, waterconsumption
•eliminations (urine,feces)
•condition ofoperative site
2.Examine closelyforother abnormalities (bandages, self-trauma).
3.Administeranalgesics based on the surgical/anesthesiaplanand/orindicationsofpain.
4.Themedicalrecordduringthisperiodmustdocumentatleastthefollowing:
•Appetiteandeliminations
•Results ofmonitoring(minimally:bodytemperature once daily)
•Anyclinicalabnormalities
•Alltreatments provided(includingdrugdosage androute ofadministration)
D.Animalactive, alert, eatingand drinkingnormally;skinsuturesin place.*
1.Examine animalup to dailyuntilthe suturesare removed (orabsorbed,inthe caseofapproved protocolsusingabsorbablesuturesintheskin);monitorconditionofoperative siteand attitude,appetiteandeliminations.
2.Sutures should beremoved within 10to 14days ofsurgery.
3.Themedicalrecordduringthisperiodmustdocumentatleastthefollowing:
•Periodicdocumentationofobservation and normalrecovery (as outlined in plan)
•Anyclinicalabnormalities
•Alltreatments provided(includingdrug, dosage androute ofadministration)
E.Animalnormal;skinsutures removed.Specific post-surgicalcare and records nolongerrequired.
*Ifprogressinrecoveryfromanesthesia is notasexpectedor ifthere aremedicalcomplications, veterinary staffshouldbe contacted immediately.
Recovery(Non-terminal) Surgeryin Rodentsand Non-mammalianVertebrates
Smallerspeciesand non-mammals presentspecialchallengesin completingsuccessfulanesthesia, surgery, and postproceduralrecovery. Animalsmustbe monitored foradequatedepth ofanesthesia, e.g., bypedal reflex. Physiologicalmonitoringisdifficultto quantitate, and is typicallyaccomplishedbysubjective analysis oftheanimal’s respiratoryrate andcharacter,and mucous membrane or skin color(when possible). Followinganesthesia/surgery, animals mustbe observed untilconscious and making gross purposeful movements.
Ingeneral, grouprecords are adequate forrodents andnon-mammals undergoingthe same procedure on the same day. Recordsshould beretainedinthe animalhousingroom, orin an accessible location, tofacilitate postoperative observation and care. Anesthesia/surgery/postoperative recordsfor rodents andnon- mammalian vertebrates mustinclude atleastthefollowing:
•Date ofprocedure
•Animal identification(s)
•Surgeon and PIname(s)
•Briefdescriptionoftheprocedure
•Time ofanesthetic induction and termination(ifgrouprecord,forfirst and lastanimal, respectively)
•Alldrugs administered, includingdose,time (forlastanimal), androute ofadministration
•Intraoperative monitoringresults,ifapplicable
•Anyabnormalities
•Documented (withtime)observation, onthe dayofsurgery, thatanimals have regainedconsciousness and are ambulatory