UMass Amherst Anesthesia/Surgery Record [find ] forms at Use this form for anesthesia and surgery records. Use the "Post-Operative Record for Lab Animals" on the Animal Care website to record longer-term post-surgery observations. Use a separate sheet for each species/surgery date/surgery type. Enter information in all the cells for each animal or enter X. Date Protocol # Species Surgery type Surgeon(s) (PLEASE PRINT) Drug Record Route of admin Anesthetic #1 and dose: Anesthetic #2 and dose: Extra anesthetic and dose: Analgesic and dose: Surgery record Time each recovery stage from anesthesia was observed (if stages seem simultaneous record the same time in each box. If a check was missed note reason under Time of: Animal Vol Vol Reflexes* Vol extra Reflexes* Vol Comments) Surgeon Animal Anesth Anesth anesth analgesia Analgesia Fully # 1 #2 delivery Not sternal awake ID initials Wt Comments Surg.start Surg.end Sternal Mobile 1 2 3 1 2 3 *Reflex 1 EYEBLINK (touch medial canthus gently); Reflex 2 EAR PINCH ; Reflex 3 TOE PINCH (pinch fore and hind toes firmly). Record either: N (none present); S (slight); or P (strongly present). Re-evaluate the anesthetic dose if there is a "P" reflex. revised 10/27/17
UMass Amherst Anesthesia/Surgery Record [find forms at ] Use this form for anesthesia and surgery records. Use the "Post-Operative Record for Lab Animals" on the Animal Care website to record longer-term post-surgery observations. Use a separate sheet for each species/surgery date/surgery type. Enter information in all the cells for each animal or enter X. Date Protocol # Species Surgery type Surgeon(s) (PLEASE PRINT) Drug Record Route of admin Anesthetic #1 and dose: Anesthetic #2 and dose: Extra anesthetic and dose: Analgesic and dose: Surgery record Animal ID Surgeon initials Animal Wt Vol Anesth # 1 Vol Anesth #2 Reflexes* 1 2 3 Vol extra anesth Reflexes* 1 2 3 Vol analgesia Time of: Time each recovery stage from anesthesia was observed (if stages seem simultaneous record the same time in each box. If a check was missed note reason under Comments) Analgesia delivery Surg.start Surg.end Not sternal Sternal Mobile Fully awake Comments *Reflex 1 EYEBLINK (touch medial canthus gently); Reflex 2 EAR PINCH ; Reflex 3 TOE PINCH (pinch fore and hind toes firmly). Record either: N (none present); S (slight); or P (strongly present). Re-evaluate the anesthetic dose if there is a "P" reflex. revised 10/27/17
anesthesiaandsurgeryrecordoctober2017_0.docx