Individual Mouse Survival Surgery Data Sheet.doc

Individual Mouse Survival Surgery Data Sheet Add IACUC Protocol Title Here (IACUC Protocol #__________ Principal Investigator:__________ ) Surgeon:____________ Anesthesia*: Ventral laparotomy: Dam body weight (g): _____ ___fiber optic transuterine microinjection Dose (μl) anesthesia: _____ Dam ID: ICR ______________ Anesthesia/Surgery Time Points: Embryo age (plug day is E0.5): __________ Injection of anesthetic is time=0 (t=0). Reagent Injected: Nembutal (ip):_t=_______ Plasmid: ______________ Toe/tail pinch/blink reflex negative:_t=__ Fast green: (Crystal): 10 picograms/5 microliters Surgery start:_ t=______ Pipette: OD____ Bevel angle:____ Surgery end:__t=______ Electroporation Paddle: 5mm Volts___ Pulses___ Duration: On:____ Off:____ Surgery/Injection Notes: Right horn: ____embryos Left horn: ____embryos ____resorbed ____resorbed Immediate Post-Operative Monitoring Date and Time Placed in Recovery Cage Time (minutes) after placement in recovery cage Animal regains consciousness Investigator (initials) Observations/Notes A checked box indicates appropriate post-surgical progress of at least the following level: Respiration: unlabored breathing Surgical site : Suture secure and incision dry/clean/no fluid or bleeding Ambulatory: mouse conscious walk attempted An X in a box is a complication (explained below): 30 Y / N Respiration  Surgical Site  Ambulatory Y/N 60 Y / N Respiration  Surgical Site  Ambulatory Y/N Complication during immediate post-surgical recovery: Expected  Unexpected  IACUC Notified Y/N Description/Remedy: 24 Hour Post-Operative Monitoring Record Date Time Investigator (initials) Observations Are the following bodily functions normal? If No, detail below and record remedy. Notes (optional) Respiration Y/N Surgical Site Y/N Eating Y/N Drinking Y/N Feces Y/N Urine Y/N Complication during post-surgical recovery: Expected  Unexpected  IACUC Not