PI Name:
Protocol #:
APPENDIX D. SURGERY
Surgery Description. All surgical procedures must be performed in compliance with the following IACUC
policies and guidelines:
 Tail Clipping Policy
 Toe Clipping Policy
 Oral Gavage in Rodents Policy
 Multiple Survival Surgery Policy
 Humane endpoints Policy
 Blood Collection Guidelines
 Guidelines for the Use of Anesthesia and Analgesia
 Rodent Survival Surgery Guidelines.
Select the statement that describes your project:
Non-survival surgery (animals are euthanized under anesthesia without regaining consciousness)
Major survival surgery (penetration and exposure of a body cavity, or resulting in a permanent
impairment of physical or physiologic functions)
Minor survival surgery (i.e. chronic implants, pumps, indwelling catheters)
Multiple survival surgical procedures. Provide the timeframe between surgeries, describe any
differences in surgical procedures, and provide a scientific justification for conducting multiple
survival surgical procedures, if applicable.

1. Location. Where will surgery be performed (building and room number)?

2. Anesthetics.
(a) List the anesthetic(s), including dosage(s), frequency of dosing, and route(s) of administration that
will be used.
Agent:
Route:
Dose (mg/kg):
Frequency:
Agent:
Route:
Dose (mg/kg):
Frequency:
Agent:
Route:
Dose (mg/kg):
Frequency:
Agent:
Route:
Dose (mg/kg):
Frequency:
(b) Describe how you will monitor the depth/quality of anesthesia to ensure it is adequate:

DOR.ORPCC.A.0D - IACUC NP Appx D Surgery
Form updated March 2015
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3. Preoperative Care. Describe any preoperative care of the animal.

4. Minimization of Contamination. Describe the methods employed to minimize microbial
contamination of the surgical site. Include brief description of the animal preparation including
preparation of the surgical site, any PPE utilized by the surgeon including sterile gloves; and how
supplies, surgical instruments, and all implants are sterilized prior to use.

5. Surgical Procedure. Describe in detail the surgical procedure from initial incision including the
anatomic area to be incised, to closure. Include any special techniques.

6. Postoperative Surgical Care. Describe the post-surgical care. Include information regarding the use
of pain-relieving drugs (give the drug(s), dosages, route(s) of administration, frequency), monitoring
of animals for normal recovery from anesthesia and wound healing, and provision of supportive care,
such as supplemental heat and fluid or antibiotic therapy. Describe who will perform post-surgical
observations, and the frequency and duration of observations.

Reminder: Documentation of the surgical procedure and post-surgical care is required and is the responsibility of the
Principal Investigator. Copies of the surgical/post-surgical records must be readily available to the veterinary staff,
the IACUC and regulatory officials.
DOR.ORPCC.A.0D - IACUC NP Appx D Surgery
Form updated March 2015
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