Kirurgi og anestesi
Forberedelse til aseptisk kirurgi - nøkkelpunkter
Prepare a protocol and a list of equipment that will be required before you start any surgical procedure.
Make sure all the required facilities and equipment have been booked.
Ensure an assistant is available.
Make sure equipment is prepared for use.
When using heat pads, monitor the temperature of both the animal and the heat pad, to ensure correct operation.
Kirurgiske instrumenterog annet utstyr
Instruments must be sterilized before they are used for aseptic surgery.
Ideally, a separate set of sterilized instruments should be used for each animal.
For batch surgery for rodents, an acceptable compromise is to sterilize the instrument tips using a hot bead sterilizer.
Instruments first need to be cleaned using a sterile brush, in sterile water, to avoid becoming clogged with organic material.
Sterile water must be used, not saline for cleaning instruments before use of a hot-bead sterilizer.
Some brands of toothbrush can be autoclaved successfully, and included in the instrument pack.
The instrument tips are briefly placed into the hot-bead sterilizer, according to the manufacturer’s instructions.
Replace them on a sterile drape, ready for use on the next animal.
Briefly immersing instruments in alcohol is NOT an effective means of sterilization.
All other materials needed for the surgical procedure that will come into contact with the surgical site must be sterile, and must be used within their stated expiry dates.
It is often convenient to purchase items such as scalpel blades and sutures in sterile packs, which are opened when required.
Delicate materials, for example catheters, which could not withstand autoclaving can be purchased pre-sterilized, or sterilized using other methods, such as ethylene oxide.
Forberedelse av dyret
Clip the fur from the surgical site after the animal has been anaesthetized.
Remove the clipped fur with a vacuum cleaner.
Perform this initial clipping in a separate area so that the operating area is not contaminated.
When clipping mice, particular care needs to be taken to avoid damaging the delicate skin.
Clean the skin using a suitable disinfectant, for example Chlorhexidine, either in alcohol or water – but avoid using too much disinfectant solution, as this can increase the risk of the animal becoming hypothermic.
Alcohol alone is not suitable for disinfection of the skin.
In both rats and mice, ointment should be applied to the eyes to prevent drying during anaesthesia (this is also true for animals undergoing imaging).
Forberedelse av kirurgen
The surgeon should wear appropriate protective clothing to avoid contaminating the surgical site.
Wearing a head cover and mask is strongly recommended, but the most important step is for the surgeon to perform effective disinfection of their hands, by “scrubbing up” and then putting on a sterile gown and sterile surgical gloves.
The process of hand-washing aims to remove surface dirt and grease from your skin, and allow sufficient contact time with the disinfectant soap to kill or inhibit bacteria in the outer layer of the skin.
The only time a scrubbing brush should be used is to clean under your nails, the remainder of the process is just careful and repeated hand-washing.
Total contact time varies with the disinfectant used – 5 minutes is recommended for Chlorhexidine and Povidone.
Forberedelse til kirurgi
An assistant should open the outer wrapping of instrument packs, sutures, and scalpel blades.
The surgeon needs to take care, when unwrapping the pack to drop the corners of the drapes, so that the back of their hand does not touch the surface of the table.
The surgeon drapes the animal, once again taking care not to touch any non-sterile surface.
Using a drape prevents sterilized items touching the animals’ fur, and becoming contaminated.
When using a paper drape, a suitable-sized hole can be cut to access the surgical site. Avoid cutting along one of the pre-folded sections as this can prevent the drape conforming to the animal.
The sterile field can be extended by using an additional paper or cloth drape.
Drapes may need to be cut to size, or positioned carefully so that the position of the animal’s nose in the facemask can be monitored – alternatively a transparent drape can be used.
Several mask designs (such as the one used to anaesthetize the mouse) provide much more secure placement of the animal’s nose.
The position of the head can be fixed using tape, but care must be taken not to interfere with respiratory movements, or to fix the animal’s limbs in an abnormal position.
Den kirurgiske prosedyren
Aseptic techniques can be maintained throughout a series of procedures but use of an assistant becomes almost essential.
After completing the first procedure, the surgeon lifts and disposes of the sterile drape.
The assistant then moves the animal to a recovery area, or directly into a warm incubator.
The next animal to undergo surgery is then anaesthetized, clipped, positioned on the table and a skin preparation undertaken by the assistant.
Ideally the surgeon will use a new set of instruments, but it is acceptable to use a hot bead sterilizer to re-sterilize the tips of the instruments.
If a new set of instruments is to be used, the surgeon should re-glove before handling them.
This can be done without the need to re-gown.
The surgeon re-drapes the animal using a new sterile drape and carries out surgery.
Med "batch kirurgi" mener vi at flere dyr anesteserer samtidig og opereres i samme "batch"
For "batch kirurgi" kirurgi gjelder følgende policy ved UiB
- Det ikke skal anesteseres mer enn 3 dyr om gangen.
- Dette er for å ivareta at dyret er tilstrekkelig anestesert og at kirurgen ikke har større arbeidsbelastning enn hva som kan gjennomføres på en tilfredsstillende måte mht aseptikk, overvåkning av anestesi og dyrevelferd.
- Hvert dyr skal opereres med sterile instrumenter (ett sterilt sett per dyr)
En videodemonstrasjon av forberedelse til kirurgi kan du se her
All animals must be monitored until fully awake. If available- use an incubator (most animals are hypothermic to a greater or smaller extent after anesthesia)
Animals must not be left incapacitated until fully awake (must be protected from cages-mates), and should only be returned to their homecage once fully awake.
Animals that have undergone invasive surgery (for example, but not limited to: intracranial or intra-abdominal surgery), sufficient post-operative pain relief must be provided. This usually requires 2-3 days of opiate treatment, but NSAID’s are also indicated.
All animals must be checked daily after surgery, and if indicated; several times a day. A note should be made in the book in the front room so that technicians are aware that the animals are seen to. The telephone number of the named surgeon must be available at all times.
The scoresheet should be used to evaluate the animals.