Red Text Is Instructions Or Examples Print Double Sided

Surgery Form [red text is instructions or examples][Print double sided]

Protocol Date: Start Finish Number: Time: Time:

Surgeons’ Name(s): Include anyone helping with anesthesia or other aspects of surgery Procedure: You can list all your Survival Non-survival approved surgical procedures and simply check the procedure being Craniotomy and electrode implantation Minipump implantation performed Ovariectomy

Animal Information: Species Animal ID Strain/Genotype Age/Gender/Other Mouse Cage card xxx; C57Bl/6; SCID; IL-4 KO 8 weeks, F Ear tag xxx

Anesthesia: Customize Isoflurane Ketamine/xylazine this for your approved 3-5% in air of O2 for 80mg/kg (k) anesthesia; if are induction; maintain @ +10mg/kg (x); IP; approved for more than 1-3%; inhalation Up to 2 boosters of one anesthetic, indicate ¼ - ½ dose of which one was used ketamine only Analgesia: Customize this Bupivicaine Buprenorphine Carprofen for your approved 5mg/kg SC; analgesia Once pre-op and every 24 hours for a total of 3 injections Other: Customize this for Saline Ophthalmic Gentamicin Thermoregulatory other approved ointment Support compounds such as 5mg/kg SC; List type – include ophthalmic ointment, Once pre-op and post-op description fluids, antibiotics every 24 hours for a total of 3 injections

Anesthetic Monitoring: [describe type of monitoring and list time]

Drugs Administered: Pre-op and intra-op Customize the sections below for your approved drugs; include all analgesia; check box to indicate administration Weight Buprenorphine Carprofen Bupivicaine/Lidocain Saline Animal ID (g) e Cage card + 32g X X X Animal ID Post-Op Monitoring & Care Customize the sections below for your approved drugs; include all compounds administered Animal ID Animal ID Day 1: Date Day 2: Date Day 3: Date Weight (g) 32g Weight (g) 32g Weight (g) 32g Buprenorphine: Time Buprenorphi Time Buprenorphine: Time A.M. ne: A.M. A.M. Buprenorphine: Time Buprenorphi Time Buprenorphine: Time P.M. ne: P.M. P.M. Saline Time Saline Time Saline Time Gentamicin Time Gentamicin Time Gentamicin Time Other drug Time Other drug Time Other drug Time Observations Observations Observations

Animal ID Animal ID Day 1: Date Day 2: Date Day 3: Date Weight (g) 32g Weight (g) 32g Weight (g) 32g Buprenorphine: Time Buprenorphi Time Buprenorphine: Time A.M. ne: A.M. A.M. Buprenorphine: Time Buprenorphi Time Buprenorphine: Time P.M. ne: P.M. P.M. Saline Time Saline Time Saline Time Gentamicin Time Gentamicin Time Gentamicin Time Other drug Time Other drug Time Other drug Time Observations Observations Observations