The PHS Policy and the Animal Welfare Act require that veterinary care be provided in accordance with currently-accepted veterinary medical practice. Major considerations in providing such care with regard to survival surgery in experimentation with animals are:

1. aseptic technique must be used for major survival surgery in nonrodent mammals;
2. surgical facilities for the performance of aseptic surgery in nonrodent mammals must meet standards of the Guide and the American Animal Hospital Association;
3. post surgical care must be provided to ensure uneventful recovery from anesthesia and surgery and to minimize pain and distress, and
4. appropriate medical records must be maintained.

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Definitions

Aseptic technique - all of the procedures and practices employed to prevent microbial contamination of the surgical site. This includes removal of hair from the surgical site, surgical scrub, use of sterile drapes, instruments and surgeon’s attire, as well as following OR protocol.

Major surgery - surgery that penetrates and exposes a body cavity, or procedures that have the potential for producing a permanent disability.

Postoperative care - observations and administration of therapeutic procedures and medications to optimize recovery from anesthesia and/or surgical manipulations and to minimize pain and distress.

Survival surgery - surgery from which the subject survives 24 hours after regaining consciousness from anesthesia.

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General Standards for Animal Surgery

Major survival surgery in non-rodent mammalian species must be performed in operating rooms intended for that purpose only. The operating room should contain only the equipment and supplies required to support the procedure being performed. Activities associated with surgery usually include the surgical procedure, surgical support, surgeons scrub, animal preparation, and postoperative care. In high-volume programs, each activity may require a separate room(s). However, it is acceptable to have a minimum of three rooms: one used exclusively for surgery; one used for surgical support and surgeons scrub, and another for animal preparation and postoperative care for animals. To comply with the Guide, all facilities for major survival surgery in non-rodent mammalian species must be used only for that purpose and must be designed and managed to ensure a level of sanitation appropriate for aseptic surgery.

Minor survival surgery in nonrodent mammals and survival surgery in rodents and nonmammalian species does not require a separate facility, but should be performed using sterile instruments, surgical gloves, and aseptic procedures to prevent infections.

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Aseptic Surgical Technique

The Operating Room (OR) walls, floors and fixed equipment should be disinfected each morning before use. Equipment that must be stored in the OR should be stored in a dust-free cabinet or covered with plastic. Equipment and carts brought into the OR for a specific procedure should be sanitized just prior to entry. Personnel and traffic should be kept to a minimum. All personnel in the OR during survival surgery should wear surgical scrubs, mask, cap and foot covers. Individuals performing the procedure must wear sterilized gowns and sterile gloves.

Surgical packs include: gowns and hand towels, glove pack (if resterilizable gloves are used), standard instrument pack, special instrument, and drape packs. In some cases packs can be combined, care should be taken in arranging their contents so they can be utilized without breaking asepsis. All surgical packs should be labeled with the contents, date sterilized, name of person who prepared the pack and for whom the pack was prepared. Packs that are prepared in advance of the surgery should be stored in a dust-free cabinet. The shelf life of stored cloth-wrapped packs is two weeks.

The animal subject should be fasted for 24 hours (drinking water should still be provided), during which time administration of medication and preoperative examinations can be preformed. Whenever practical, the animal should be bathed and steps taken to ensure the bladder and bowel have been evacuated prior to surgery. In the animal preparation room, the surgical site and surrounding area should be clipped with a coarse clipper. The immediate surgical site is then clipped with a #40 clipper head and loose hair is removed from the animal with a vacuum cleaner. Clipping is usually done after induction of anesthesia and endotracheal intubation. After the animal is clipped, the surgical site is scrubbed gently but thoroughly with an antiseptic soap, such as Betadine scrub, rinsed and dried.

In the OR, the animal is placed on the surgery table and held in place by soft rope ties or other appropriate means. Care should be taken to avoid restricting circulation or access to veins. Using sterile supplies, a fully gowned and gloved assistant then performs the final animal subject skin preparation. The surgical site is scrubbed with an antiseptic scrub solution starting at the immediate incision site and working outward in a circular fashion, then rinsed with sterile saline. This procedure is repeated at least twice. The surgical site should then be blotted dry with a sterile towel and a thin layer of an antiseptic solution, such as Betadine solution, is applied by either painting or spraying and allowed to air dry.

The surgeon should don cap and mask and then scrub his or her hands three times, starting with the fingers and working up to above the elbows. The hands are then dried with a sterile towel, again starting with the fingers and working up to above the elbows. A sterile gown is then donned by lifting it off of the pack by the inside of the partly-inverted sleeves, taking care not to touch the outside of the gown with the hands or any nonsterile surface. The arms are then passed into the sleeves without pushing the hands beyond the cuffs. The gown is then tied by an assistant.

Sterile gloves are put on after the sterile gown. In donning sterile surgical gloves, the bare hand must never touch the outer surface of the glove. Open the glove packet with hands covered with the cuffs of the gown. Hold one glove by the folded-over inner surface edge of glove and insert the other hand into the glove. To put on second glove, hold it with the fingers of the already-gloved hand placed under the folded-over glove cuff and slip hand into it.

A general method for draping an animal subject for operation on the body trunk is to place four drapes with their edges around the immediate incision site to minimize contamination from surrounding skin. Then a larger fenestrated drape is placed over the animal and the entire surgery table to provide a large sterile field. When the skin has been incised and hemorrhage arrested, skin drapes are attached to the edges of the incision by the surgeon.

The surgical packs are kept away from the surgical table until the animal subject is completely draped, and should remain sealed until they are needed. Packs are opened by an assistant without touching the inner surface of the wrapper. The seal of the pack is broken and the edge of the wrapper are pulled out by its outer surface and draped over the instrument stand.

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Multiple Major Survival Surgery

Multiple major survival surgeries on a single animal are generally not permitted. They may be permitted provided they are related, essential components of a research or instructional project requiring more than one intervention in the same animal and are approved by the ACUC. Cost alone is not adequate justification for multiple major survival surgeries.

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Postoperative Care

Professional and regulatory guidelines require the provision of adequate postoperative care for research animals and the maintenance of appropriate medical records. These responsibilities are the Principal investigator’s.

Following surgery or anesthesia, animals should be placed in a clean, quiet environment where they can be observed closely and continuously while they recover. All food and water bowls and any other physical hazards should be removed from the cage where the animal is recovering from anesthesia. (In dog cages with brackets for food and water bowls in the door, the bowls should be put in upside down to prevent the animal from accidentally hanging itself.) Trained personnel should be available to deal with emergencies.

During the postoperative period, a monitoring record must be kept in the room where the animal is housed. It must include the findings of each physical examination during the recovery period. It should also include a brief description of the surgical procedure, anesthetic used, time of induction, duration of surgical anesthesia, and the time the animal is returned to the cage. Individual records must be maintained for each rabbit, cat, dog, pig, ruminant, non-human primate and other mammals larger than rodents. Postoperative records facilitate the postoperative care of animals and should be retained as a part of their permanent medical record. For rodents, a group record describing the procedure, the date(s) performed and the anesthetic agent(s) may be kept. Blank postoperative record cards are available from OAR, 1720 E Campus Loop.

Medical monitoring should be done on animals according to the extent of recovery from surgery and anesthesia. The animal’s condition and the surgical procedure performed determine the need for further supportive care, e.g. fluids, electrolytes, analgesics, antibiotics, etc. Nonrodent mammals should be examined and the findings recorded according to the following schedule:

A. Animal unconscious or semi-conscious; unable to sit or maintain sternal recumbency.

1. Examine the animal and record findings not less than hourly. Examples of notations include:

   1. body temperature
   2. heart rate
   3. respiratory rate
   4. capillary refill time - record in seconds
   5. jaw tone - record resistance or no resistance
   6. response to toe pinch - record withdrawal or no withdrawal
   7. time of extubation
2. The animal should be turned from side to side frequently to prevent dependent pulmonary congestion and edema.
3. Ambient temperature should be adjusted (heat lamp or warming board) to maintain normal body temperature. The animal should be kept dry.
4. The state of hydration should be assessed and fluids should be provided as necessary.

B. Animal conscious and can maintain sternal recumbency or sit but cannot stand.

1. Examine and record findings not less than every 6 hours depending on the nature of the surgery and the status of the animal. Examples of notations include:

   1. body temperature until it becomes normal + 2o F
   2. capillary refill time
   3. condition of the operative site
2. Examine closely for other abnormalities.
3. Keep the animal dry and adjust the ambient temperature to bring the body temperature to normal.
4. Consider use of analgesic medication.

C. Animal can stand and move about; not eating and drinking normally.

1. Examine twice daily and record findings. Examples of notations include:

   1. body temperature
   2. hydration
   3. attitude - alert or depressed
   4. activity - active or inactive
   5. food consumption - blank charts available from OAR
   6. water consumption
   7. condition of operative sit
2. Examine closely for other abnormalities.
3. Consider use of analgesic medication.

D. Animal active, alert, eating and drinking normally; skin sutures in place.

1. Examine daily and keep a post-surgical record of surgical site care until the sutures are removed.
2. Sutures should be removed within 10-14 days of surgery.

E. Animal normal; skin sutures removed.

1. Specific post-surgical care and record no longer required.

As a service to investigators, OAR can provide post-surgical care on a fee for service basis. Prior arrangements should be made through the OAR office at least three days in advance.

If progress in recovery from anesthesia isn’t as expected or if there are medical complications, the OAR veterinary staff should be contacted (call 2-3111). On weekends and holidays the UMMC Hospital Security Office can contact the veterinarian on call. OAR can also provide clinical laboratory support or instruct your staff on postsurgical care.

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Rodent Surgery

Survival surgery on rodents does not require special facilities, but should be performed using sterile instruments, surgical gloves, and aseptic procedures to prevent clinical infections. In general, adequate conditions can be established by clipping the hair, scrubbing the surgical site, and placing the animal on a disinfected or draped laboratory bench or table.

In general, group records that list animal identification numbers, describe the surgical procedure, give the date performed and anesthesia being used are adequate for rodents. Records should be retained in the animal housing room to facilitate postoperative care.

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Minor Surgical Procedures

Minor surgical procedures such as peripheral vessel cannulation, subcutaneous implants, laparoscopy, percutaneous biopsies, etc., can be performed under less stringent conditions if they are performed in accordance with standard veterinary practice.