OPERATION REPORT



|PI: Species: Animal ID______________ Date: |

|_____________Weight___________ Protocol# Procedure:___________________________________________ Surgeon:_______________________ |

|Assistant:____________________________ |

|Anesthetist: __________________________ Animal Fasted: □ Yes □ No |

|Remarks: _________________________________ |

Premed, Induction, Anesthetic & Analgesic Drugs

|Time |Drug |Total mls given |Dose (total, recorded in mg) |Route |Initials |

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Maintenance

Endotracheal tube size: ____________________

Gas Anesthesia no yes ( Isoflurane Sevoflurane Start time:____________________

Extubation time:_______________

Respiration spontaneous rebreathing/non-rebreath(time) ________ ventilator (time)__________

Fluid type and rate (ml/hr): Fluid total (mls):

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

|Time |% Gas |Temp |HR/RR |SPO2 |ETCO2 |Surgical Events/Other Comments/ |Initials |

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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% GasTempHR/RRSPO2ETCO2Surgical Events/Other Comments/

Additional DrugsInitials



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