Individual Mouse Survival Surgery Data Sheet

Page_____ Date: ______Dam ID #: ______Individual Mouse Survival Surgery Data Sheet Add IACUC Protocol Title Here (IACUC Protocol #______Principal Investigator:______) Surgeon:______Anesthesia *: Ventral laparotomy: Dam body weight (g): ______fiber optic transuterine microinjection Dose (µl) anesthesia: _____ Dam ID: ICR ______Anesthesia/Surgery Time Points: Embryo age (plug day is E0.5): ______Injection of anesthetic is time=0 (t=0). Reagent Injected: Nembutal (ip):_t=______Plasmid: ______Toe/tail pinch/blink reflex negative:_t=__ Fast green: (Crystal): <10 picograms/5 microliters Surgery start:_ t=______Pipette: OD____ Bevel angle:____ Surgery end:__t=______Electroporation Paddle: 5mm Volts___ Pulses___ Duration: On:____ Off:____

Surgery/Injection Notes: Right horn:____embryos Left horn:____embryos ____resorbed ____resorbed

*anesthesia: 7.5 µl/gram body weight of a solution containing 9 mg/ml Nembutal, 20.8 mg/ml MgSO4, 10% ethanol, and 40% propylene glycol. Page_____ Dam ID #:______Immediate Post-Operative Monitoring Date Time Animal Investigator Observations/Notes and (minutes) regains (initials) A checked box indicates appropriate post-surgical progress of Time after consciousness at least the following level: Placed in Respiration: unlabored breathing placement Surgical site : Suture secure and incision dry/clean/no fluid Recovery in Cage or bleeding recovery Ambulatory: mouse conscious & walk attempted cage An X in a box is a complication (explained below): 30 Y / N Respiration Surgical Site Ambulatory Y/N 60 Y / N Respiration Surgical Site Ambulatory Y/N Complication during immediate post-surgical recovery: Expected Unexpected IACUC Notified Y/N Description/Remedy:

24 Hour Post-Operative Monitoring Record Date Time Investigator Observations Notes (initials) Are the following bodily functions normal? (optional) If No, detail below and record remedy. Respiration Y/N Surgical Site Y/N Eating Y/N Drinking Y/N Feces Y/N Urine Y/N Complication during post-surgical recovery: Expected Unexpected IACUC Notified Y/N Description/Remedy:

Management of Experimental Embryos and Pups ___Dam sacrificed: Date: ______Time: ______Embryonic age: ______Natural birth: Date: ______Date/time pups sacrificed: ______Postnatal age of pups: ______Embryo/tissue processing: Fixation: perfusion 2% paraformaldehyde/0.5% glutaraldehyde in PBS immersion 4% paraformaldehyde in PBS other______

Affix copy of vial label here

Notes:______Page_____ Date: ______Dam ID #: ______

*anesthesia: 7.5 µl/gram body weight of a solution containing 9 mg/ml Nembutal, 20.8 mg/ml MgSO4, 10% ethanol, and 40% propylene glycol.