SDSU Institutional Animal Care and Use Committee
Animal Protocol Form (APF)
Surgery
Supplement 6
For Official Use Only
APF #:
Submission Date:
Approval Date:
PI Name:
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8th Edition of the Guide for the Care and Use of Laboratory Animals, Page 117 “Surgical
Procedures:”
Surgical procedures are categorized as major or minor and, in the laboratory setting [and field settings], can
further be divided into survival and non-survival. When attempting to categorize a particular surgical
procedure, the following should be considered:
 The potential for pain and other postoperative complications
 The nature of the procedure as well as the size and location of the incisions
 The duration of the procedure; and the species, health status, and age of the animal
Other Reference documents:
 Surgery, Rodent Non-Survival
 Surgery, Rodent Survival
1. Classification of Surgical Procedures
Select all that apply to this protocol submission
☐ Major Survival Surgery
☐ Minor Survival Surgery
☐ Multiple Survival Surgeries (one animal)
☐ Non-survival Surgery
a. If more than one surgery is performed on the same animal, provide the justification.
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b. Has any major or minor survival surgery been performed on any animal prior to its use
on this study (i.e. indwelling catheters, implants, etc.)? If yes, explain.
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2. Surgical Procedures
a. Identify and describe any surgical procedure(s) to be performed. Include details such as
surgical approach, relevant anatomy, tissues manipulated, anticipated duration of surgery,
surgical instruments and materials used, methods of incision closure and suture removal.
Include any indwelling catheters or implants (i.e. intravenous catheters, arterial catheters,
intracranial electrodes or canulae, subcutaneous pumps or pellets, etc.).
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Version June 15, 2015
SDSU Institutional Animal Care and Use Committee
Animal Protocol Form (APF)
Surgery
Supplement 6
b. Describe aseptic methods used in the performing of surgical procedures (i.e. instrument
sterilization methods, sterile draping, patient preparation, surgeon garb).
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c. Describe measures to monitor and support patients during surgery such as the monitoring
parameters, method of assessing anesthetic depth, and provision of supportive care such as
supplemental heat and fluids.
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d. Will paralytic agents be used during surgery? If yes, describe how respiration, circulation and
pain will be assessed.
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e. For each surgery, list the number of animals expected to undergo the procedure and discuss
potential failure rates, associated mortality, possible complications and methods to address
these factors.
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3. Pre-operative Procedures
a. Describe pre-operative procedures including any pre-medication with analgesics, antibiotics,
etc., and patient preparations such as fasting.
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b. Describe measures to monitor and support patients during the pre-operative phase such as
the monitoring parameters and the provisioning of supportive care such as supplemental heat
and fluids.
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4. Post-operative Procedures
a. Describe measures to monitor and support patients during the immediate post-operative
recovery phase including monitoring frequency, methods of assessing pain and distress,
methods of alleviating pain and distress, provision of medications and supportive care such as
supplemental heat and fluids.
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b. Describe the monitoring and support of patients during the days following surgery including
monitoring frequency, methods of assessing pain and distress, methods of alleviating pain
and distress, provision of medications and supportive care such as dietary supplements,
supplemental heat and fluids. Include provisions for after hours, weekends and holidays.
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c. Procedure/Surgery/Monitoring log sheets must be maintained and will be subject to review
by the IACUC, OLAC or Veterinarians upon request. Examples of log sheets can be found: Log
Sheet Procedure or Surgery and Log Sheet procedure or Surgery Post-op. Guidance can be
obtained from the Surgical Management, Monitoring and Record Keeping Guidelines.
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Version June 15, 2015
SDSU Institutional Animal Care and Use Committee
Animal Protocol Form (APF)
Surgery
Supplement 6
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5. Anesthesia, Analgesia, Tranquilizers, Other Drugs
Please complete the table below and Supplement 4
Surgical Procedure
Name of substance administered (i.e.
isoflurane, buprenorphine, etc.)
Purpose (i.e. anesthesia, analgesia,
antibiotic, etc.)
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6. Pain, Distress and Endpoints
Describe the criteria used to determine endpoints related to surgical complications and/or if pain
and distress are unalleviated. Criteria might include immobility, huddled posture, inability to eat
or drink, weight loss, ruffled fur, lameness, paralysis, or self-mutilation).
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7. Personnel
Identify the individual(s) that will perform surgery and describe their qualifications, training, and
experience. Note: Also include them in Section A PERSONNEL in the Main APF.
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8. Location of Surgery
Identify the location where surgery will be performed (building, room #, field location, etc.)
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Version June 15, 2015