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Survival Surgery Non-Rodents

Case Western Reserve University
Institutional Animal Care and Use Committee
Revised December 20, 2001

This document outlines the federal and institutional requirements for performing survival surgery on non-rodent species at CWRU and its affiliated facilities. The sources of federal standards include the Animal Welfare Act (USDA) and the NIH's Guide for the Care and Use of Laboratory Animals (National Academy Press, 1996).

Definitions

Non-rodent species include rabbits, and all species considered higher than rabbits, on the phylogenetic scale. Examples include rabbits, ferrets, cats, dogs, nonhuman primates (NHP), and farm species used in biomedical research. The definition EXCLUDES species such as rats, mice, hamsters, guinea pigs, gerbils, frogs, and fish.

Survival surgery includes any surgical procedure in which the animal is expected to awaken from anesthesia. This includes procedures in which the animal is expected to survive for a very short time.

Major surgery, survival or nonsurvival, includes procedures that penetrate and expose a body cavity or produce substantial impairment of physical or physiologic function.

Before Beginning

During the protocol review process, the IACUC reviewer will determine the researchers' level of experience and comfort with the proposed surgical procedures. This is done primarily through the use of the Personnel Health and Training (PHT) forms. The investigator may choose to hire the ARC veterinary technicians to perform such procedures as anesthesia and surgical prep. Training for general surgical preparations is also available from the ARC veterinary technicians. Training in specialized procedures may be available from the ARC veterinarians or fellow investigators. The ARC can also reserve animal carcasses for practice procedures if needed.

The investigator and staff must check to see that all proposed procedures, including appropriate anesthesia and monitoring, are contained in an approved, active protocol. Also, the protocol should be checked to assure that all quarantine and conditioning procedures have been followed. This is especially important if the animal must be conditioned prior to surgery (a random-source animal) or will be subjected to a novel procedure at any time during the procedure (animal must wear jacket after surgery to protect electrode wires).

The investigator should reserve the surgical suite by contacting the ARC veterinary technicians as soon as the date of the procedure is known. At least 24 hours prior to the surgery, the investigator must submit a completed Procedure Data Sheet to the ARC, outlining the details of the procedure, and any assistance or supplies needed from the ARC. This sheet also indicates a primary and secondary research contact for use by the ARC in case of post-operative problems.

Location

Both the AWA and the Guide require that major survival surgery on non-rodent species be conducted in facilities intended only for that purpose. At CWRU, these facilities include the ARC surgical suites at the Medical School and the Rammelkamp facility at MetroHealth Medical Center, as well as other IACUC-approved facilities utilized by the Applied Neural Control Laboratory and the Department of Orthopaedics. No major survival surgery on non-rodents may be performed outside of these facilities.

Occasionally, non-rodents require minor survival surgical procedures such as catheter placement, skin biopsy, etc. While the regulations do not require that these be performed in a dedicated surgical suite, they still require aseptic procedures and instruments, and adequate anesthesia. The IACUC recommends that even minor non-rodent survival surgery be performed in the surgical suite, or in an appropriate room in the ARC. This prevents excess transport of anesthetized animals, especially as they are awakening from anesthesia.

Preoperatively

The investigator should select a healthy animal for the procedure. All animals except rabbits should be fasted the night before the procedure. "No food" signs for the animals' cages are available from the ARC.

The surgical team should arrive at the ARC on time, and be familiar with the anesthetic and monitoring procedures, as well as the surgical and post-operative procedures planned for the animal. The team should also make sure that all necessary equipment and personnel are available before the animal is anesthetized. All surgical instruments should be properly wrapped, and adequately sterilized by steam or gas methods.

Surgical Preparation

The approved anesthetic regimen should be followed. Placement of intravenous (IV) catheters should be done aseptically for survival surgeries. All instruments and records needed for anesthetic monitoring should be ready for use when the animal is anesthetized.

For major survival surgical procedures, intravenous fluid support should be provided to the patient. Generally fluid such as Lactated Ringer's is provided at a rate of 5-10 ml/lb/hour, (10-20 ml/kg/hour) plus any additional needed for blood loss.

Once the animal is anesthetized, the hair is clipped away from the surgical site. This should be done in the prep room and NOT in the surgical suite. If the animal's skin is dirty, the investigator may choose to wash the area prior to moving the animal to the operating room.

The animal should be placed on an external heating source, such as a heating pad. The ARC recommends a water-circulating pad to decrease chances of animals being burned. One of these pads is available for rental from the ARC, for use in its surgical suites only.

The animal may be moved into the operating room after it has been clipped. The animal must then be prepped for surgery. Sterile equipment and gloves must be used, and the scrubbed area should be twice that of the expected surgical field. The proper scrubbing motion includes a series of circles that widen away from the incision site. The ARC veterinary technicians can demonstrate the proper scrub technique.

All personnel directly involved with the surgical process must wear a sterile gown and gloves, in addition to a cap, mask, and shoe covers. These people must perform a surgical scrub of their hands and lower arms prior to donning surgical garb. All other personnel in the room must wear a cap and mask. Traffic in the operating room should be restricted to necessary personnel, and trainees and observers on a very limited basis.

Intra-operatively

Follow sound principles of surgical technique. These include gentle handling of tissues, adequate hemostasis, keeping exposed tissues moist with sterile saline, maintaining sterility of surgical field, and keeping track of equipment, especially sponges and small articles that could be left inside patients.

Immediate Post-operative Period/Anesthesia Recovery

Unless prior arrangements are made with the ARC veterinary staff, all post-procedural monitoring is the responsibility of the investigator and his/her staff.

Animals that have been intubated with an endotracheal tube should be monitored continuously until the tube has been removed. After extubation, the animals should be checked at least every 30 minutes until they can lift and maintain themselves in a sternal position.

Animals that were not intubated should be monitored at least every 30 minutes until they can achieve and maintain a sternal position. Notations on all post-procedural observations must be recorded on the yellow Post-Anesthesia Monitoring Card, which is available from the ARC. This card should be affixed to the animal's cage records after anesthetic recovery.

The animal should be placed in a clean dry cage for anesthetic recovery. All objects, such as bowls or toys, should be removed when possible to prevent the animal from hitting them while waking up from anesthesia. These objects may be replaced when the animal has recovered.

Any problems with the post-operative recovery should be reported immediately to the ARC veterinary staff.

Balance of post-operative period-up to 14 days

Post-operative animals should be checked at least daily, and more often if circumstances require. Animals' temperatures should be recorded for at least three days post-operatively if possible. Incisions should be checked at least daily until sutures or surgical staples are removed at 14 days post-operatively. Bandages should be checked at least daily, and changed at least weekly (more often if wet, dirty or damaged). The general condition of the animal, including appetite, stool, and attitude, can be checked at this time.

Analgesics should be used for at least three days after a major surgical procedure. Their use can be extended as needed. Analgesics should be given whenever there is a question regarding animal pain or discomfort. A useful rule of thumb is that a procedure should be expected to cause pain in an animal whenever a similar procedure is expected to cause pain in a human.

Unless prior arrangements have been made with the ARC veterinary staff, suture or surgical staple removal is the responsibility of the investigative staff. All observations on the animal's post-operative condition must be recorded at the time of observation on its cage card. The notations should also include the initials of the recording observer. Animals wearing restraint jackets, splints, bandages or Elizabethan collars must be observed on a daily basis with documentation of observation on the animal's cage card. The ARC can provide cage card preprinted with monthly calendars to simplify this process. A form for postoperative evaluation is available here.

Multiple major survival surgeries

Both the AWA and the Guide strongly discourage multiple major survival surgeries on one animal. In some circumstances, such as related components of a research project, conservation of endangered species, or clinical considerations. These circumstances must be accompanied by a written request by the investigator, identifying the necessity and scientific justification for such a procedure. These situations are identified at the time of protocol review, and may be reviewed by the IACUC at its monthly meeting.