1	Survival Surgery Guidelines Nanette R. Kleinman, DVM, DACLAM Associate Director Animal Resource Center Case Western Reserve University
2	Animal Welfare Act Provisions Relating to Animal Research Procedures involving animals will avoid or minimize discomfort, distress and pain
3	Provisions Continued The Principal Investigator must have considered alternatives to procedures that cause more than momentary or slight pain The experiment must be prepared in consultation with the attending veterinarian with the appropriate use of sedatives, analgesics or anesthetics Experiments must not be performed using muscle paralyzing agents without adequate anesthesia Animals that would otherwise experience severe unrelieved pain or distress must be euthanized.
4	Provisions Continued Research personnel must be qualified and trained in the procedures they perform All surgery must be accompanied by appropriate pre-operative and post-operative care. All survival surgery must be performed using aseptic technique No animal may be used in more than one major operative procedure unless it is scientifically justified or required for the health of the animal
5	Before Beginning All proposed procedures and animal care must be contained within an approved and active IACUC procotol. Training and expertise of investigatory staff is assessed at the time of protocol review.
6	The Veterinary Services Staff Veterinary Services can provide training in animal handling, restraint, anesthesia, surgical asepsis and post op care Veterinary Services may also be contracted to perform experimental procedures
7	Major Survival Surgery Penetrates and exposes a body cavity or produces substantial impairment of physiologic functions Rodents Dedicated operating area not required Aseptic technique required Non-rodents Dedicated operating area required Aseptic technique required
8	Survival Surgery Animal recovers consciousness, even momentarily, requires Aseptic Technique Hair removal and disinfection of the operative site Use of sterilized instruments (alcohol soak not acceptable) Use of proper surgical attire including surgical gloves, and masks
9	Rodent Species
10	Rodent Surgeries May be performed in your lab Surgical records are kept with the cage card Aseptic technique and postoperative care should be followed as described in this presentation
11	Nonrodent Species
12	Reserving a Surgical Suite Call the Veterinary Technicians Office (x2507) to schedule a surgery day and time. Submit a Procedure Data Sheet to Veterinary Technicians Office, EB12A, as far in advance as possible but no less than 48 hours prior to surgery. Procedure data sheets are available at http://labanimals.cwru.edu, the Vet Tech Office, EB12A or the ARC Office, TB03A.
13	The Day Before Surgery Select a healthy animal for surgery All species except rabbits should be fasted the night before scheduled surgery. NO FOOD labels may be picked up from Veterinary Technician Office, EB12A
14	The Day of Surgery Arrive on time. Make sure all needed equipment to be provided by the PI is present and prepared.
15	Surgical Prep Enter initial data in the anesthetic recovery record. Aseptically place an IV catheter. Intraoperative fluid requirement is 10-20 ml/kg/hr of sterile IV fluid such as Lactated Ringer’s Solution, 0.9% NaCl or 5% dextrose IV lines may be omitted for rabbit surgeries of short duration
16	Induction of Anesthesia Administer anesthesia IM or IV to effect Follow quickly with endotracheal intubation Muscle relaxants are not needed for animal intubation Depending on the species or surgical procedure, intubation may be omitted
17	Preparation of the Surgical Site Clip the fur from an area twice as large as the expected surgical site. A preliminary surgical scrub may be done at this time Move the animal to the operating room Place the animal on a drape covering a water circulating heating pad on the surgical table
18	Preparation of the Surgery Site Sterile equipment and gloves are used The scrubbed area is twice as large as the expected surgical field Use a 4x4 pad and betadine or chlorhexidine as a surgical scrub
19	Surgical Prep, continued Scrub using circular motion which begins in the center of the field and widens to the edges. Discard the 4x4 sponge. Repeat 6 times alternating betadine scrub and alcohol Spray the scrubbed area with betadine solution
20	Preparation of the surgeon Wear a scrub suit or roll sleeves above elbows Remove all jewelry from hands and wrists Put on a surgical cap and mask Scrub all surfaces of the hands and arms for 5 minutes with betadine scrub or chlorhexidine scrub
21	Surgical Scrub Rinse holds hands up so that dripping is toward elbow Dry with towels in surgical pack
22	Put on the Surgical Gown Touch only the inside of the gown with ungloved hands A nonsterile “circulating nurse” is needed to tie the back of the gown
23	Put on Sterile Gloves Open the surgical glove packet without touching the inside Put on the LEFT glove Touch only the INSIDE of the glove with your bare right hand Put on the RIGHT glove Touch only the OUTSIDE of the glove with your gloved left hand
24	Drape the Surgical Site Towel drapes Drape the side nearest you first Follow with the sides Drape the side farthest away from you last Final drape Cover the towel drapes with a large drape
25	Intraoperatively Follow sound principles of surgical technique Gentle handling of tissues Keep exposed tissues moist with sterile saline Maintain the sterility of the surgical field Keep track of small pieces of equipment and surgical sponges All survival procedures will be monitored initially by a Veterinary Technician until proficiency has been assessed
26	The Immediate Post Op Period Unless prior arrangements are made with Veterinary Services, all post procedural monitoring is the responsibility of the investigatory staff.
27	Recovery from Anesthesia Monitoring is continuous until extubation Then, every 30 minutes until the animal is sternal
28	Post Operative Monitoring Daily until sutures are removed and animal has stabilized Use SOAP format Subjective Objective Assessment Plan
29	SOAP Example Subjective: Appears painful, depressed Objective: Temp 101^oF, incision clean and intact, minimal swelling, Not eating much. Normal color, hydration Assessment: No sign of infection. Post-operative pain Plan: Give buprenorphine, tempt to eat, monitor weight, continue observation
30	Analgesia – Pain Relief If a procedure is known to be painful for humans, assume it is equally painful for animals Know the signs of pain in the species you work with Most lab animal species do not demonstrate signs of pain well Preemptive analgesia for all animals is recommended http://iacuc.cwru.edu/policy/analganesth.html The ARC veterinarians can recommend appropriate methods of providing analgesia
31	Suture Removal Unless sutures are buried or absorbable, suture and/or surgical staple removal for all species must be done by 14 days post surgery.
32	Remember The Veterinary Services Team is here to assist you in all your protocol needs
33	Survival Surgery Test Congratulations! Please document your training by completing the Survival Surgery Test