Principle Investigator: Date: Surgeon: Protocol Number: Species: Animal ID Number: Body Weight: Protocol Surgical Procedure Name: Anesthetic Drugs Administered Drug Dose Volume used Volume of Drug Stock Route of Time Given Administered for cocktail Cocktail Concentration Administration (mg/kg) (mL) Administered (mg/mL) Ketamine Dose 1_______ Dose 1_______ Dose 1_______ Dose 1_______ Dose 1_______ Dose 1_______ (30-50% supplemental dose, if Dose 2, if needed) needed______ Dose 2_______ Dose 2_______ Dose 2_______ Dose 2_______ Dose 2_______ Dexmedetomidine Xylazine Isoflurane Bupivacaine Lidocaine (if bupivacaine is not available) Atipamezole (Dexmeditomidine reversal) Analgesic Drugs Administered *choose one and one Narcotic Buprenorphine Meloxicam Ketoprofen Carprofen Surgery Notes and Observations Time Surgery Started: Time Surgery Ended: area shaved or hair removed Describe any anesthetic, surgical, or post‐operative Surgical site cleaned with betadine/iodine & alcohol, 3 alterations complications: Surgical ointment applied Ophthalmic source provided Heat reflex (toe pinch) checked Bi-Pedal Extubated Intubated  - head cover, gown, mask, provided (if necessary); volume ________________ Surgeon Fluids - hands washed/alcohol hand rub, sterile surgical gloves drugs put away and locked Surgeon Controlled pad and nestlet in cage Recovery Temperature Monitoring Parameters 0 min 15 min 30 min 45 min 60 min 75 min (from protocol) Toe Pinch (withdrawal reflex) Respiratory Rate subjective – assessment
Principle Investigator: Date: Surgeon: Protocol Number: Species: Animal ID Number: Body Weight: Protocol Surgical Procedure Name: Anesthetic Drugs Administered Drug Dose Administered (mg/kg) Volume used for cocktail (mL) Volume of Cocktail Administered Drug Stock Concentration (mg/mL) Route of Administration Time Given Ketamine (30-50% supplemental dose, if needed) Dose 1_______ Dose 2, if needed______ Dose 1_______ Dose 2_______ Dose 1_______ Dose 2_______ Dose 1_______ Dose 2_______ Dose 1_______ Dose 2_______ Dose 1_______ Dose 2_______ Dexmedetomidine Xylazine Isoflurane Bupivacaine Lidocaine (if bupivacaine is not available) Atipamezole (Dexmeditomidine reversal) Analgesic Drugs Administered *choose one and one Narcotic Buprenorphine Meloxicam Ketoprofen Carprofen Surgery Notes and Observations Time Surgery Started: Time Surgery Ended: Surgical area shaved or hair removed Surgical site cleaned with betadine/iodine & alcohol, 3 alterations Ophthalmic ointment applied Heat source provided Bi-Pedal reflex (toe pinch) checked Intubated Surgeon - head cover, gown, mask, Surgeon - hands washed/alcohol hand rub, sterile surgical gloves Describe any anesthetic, surgical, or post‐operative complications:  Extubated Fluids provided (if necessary); volume ________________ Controlled drugs put away and locked Recovery pad and nestlet in cage Temperature Monitoring Parameters (from protocol) 0 min 15 min 30 min 45 min 60 min 75 min Toe Pinch (withdrawal reflex) Respiratory Rate – subjective assessment
Rodent-Surgical-Record-Template.docx