UNIVERSITY OF CALIFORNIA, LOS ANGELES
UNIVERSITY OF CALIFORNIA, LOS ANGELES
Surgical and Post-Operative Evaluation Record for Mice, Rats, and Birds
Animal # Species Procedure Date
PRE-OPERATIVE PREPARATION AND EVALUATION
|Pre-Op Weight: |Pre-Op Physical |Pre-Op Medications (e.g., pre-operative analgesia) |Pre-Op Preparation (e.g., fasting, water deprivation) |
| |Exam: | | |
ANESTHESIA
| |
|ANESTHETIC INDUCTION |
| |
|Drug |
|Dose |
|Route |
|Time |
| |
| |
| |
| |
| |
| |
|GAS ANESTHESIA |
|Time |
| |
| |
|:00 |
|15 |
|30 |
|45 |
|:00 |
|15 |
|30 |
|45 |
|:00 |
|15 |
|30 |
|45 |
|:00 |
|15 |
|30 |
|45 |
|:00 |
|15 |
|30 |
|45 |
|:00 |
| |
|Isoflurane (%) |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
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| |
| |
SURGICAL PROCEDURES AND INTRA-OPERATIVE MONITORING
|Intra-Operative Monitoring: (e.g. body temp, toe pinch, corneal reflex) |Description of Procedures: |
|Other Intra-Operative Drugs (include dose, route, and time): |Intra-Operative Complications: |
| | |
|Fluid Administration (if applicable): |Recovery Observations: |
POST-OPERATIVE MEDICATIONS, MONITORING AND EVALUATION
Medications: (Please include name, dose, route, and time(s) of administration.)
|Date/Initials: | / | / | / |
ANESTHESIA
| |
|ANESTHETIC INDUCTION |
| |
|Drug |
|Dose |
|Route |
|Time |
| |
| |
| |
| |
| |
| |
|GAS ANESTHESIA |
|Time |
| |
| |
|:00 |
|15 |
|30 |
|45 |
|:00 |
|15 |
|30 |
|45 |
|:00 |
|15 |
|30 |
|45 |
|:00 |
|15 |
|30 |
|45 |
|:00 |
|15 |
|30 |
|45 |
|:00 |
| |
|Isoflurane (%) |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
SURGICAL PROCEDURES AND INTRA-OPERATIVE MONITORING
|Intra-Operative Monitoring: (e.g. body temp, toe pinch, corneal reflex) |Description of Procedures: |
|Other Intra-Operative Drugs (include dose, route, and time): |Intra-Operative Complications: |
| | |
|Fluid Administration (if applicable): |Recovery Observations: |
POST-OPERATIVE MEDICATIONS, MONITORING AND EVALUATION
Medications: (Please include name, dose, route, and time(s) of administration.)
Date/Initials: | / | / | / | / | / | / | / | |Analgesia: | | | | | | | | |Analgesia: | | | | | | | | |Antibiotics: | | | | | | | | |Other/fluids/drugs | | | | | | | | |Clinical Observations (e.g. activity, grooming, respiration, vocalization, eating/drinking, urination/defecation, cachexia, gait impairment/paralysis) | | | | | | | | |Body Weight:
(if weight loss occurs include % change from pre-operative body weight) | | | | | | | | |Incision Monitoring: (e.g., redness or swelling around/under incision, exudate from surgical site) | | | | | | | | |Other Notes:
| | | | | | | | |Suture/Wound Clip Removal: (Date) ______________
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PI:
ARC #
Surgeon:
PI:
ARC #
Surgeon:
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