However, this regulatory and documentation process may lead to the use of a few possibly oversimplified anesthetic protocols used for mouse procedures and anesthesia. Sufficient documentation of the anesthetic event and procedure should also be performed to meet the legal, ethical, and research reproducibility obligations. It is critical to perform anesthesia according to the approved research protocol using appropriately handled and administered pharmaceutical-grade compounds whenever possible.Payment may be made under the Medicare physician fee schedule at the regular fee.Anesthesia, animal research, animal welfare, Mus musculus, refinement INTRODUCTION BackgroundThe laboratory mouse ( Mus musculus) is popular in animal research because of its small size relative ease of care established and varied scientific procedure protocols, including genetic manipulation and the availability to purchase established genetic lines. Step 6: MAC Services Modifier Description QS Monitored anesthesia care service G8 Monitored anesthesia care (MAC) for deep complex,Department of Anesthesiology, Office of Compliance, CDQ and PBG. This article utilizes key points for easy access of important messages and authors’ recommendation based on the authors’ clinical experiences.If a service is intended to be MAC and at any point the patient is unable to control their own airway, the service is no longer considered a MAC service and should be reported as general anesthesia. The authors include experiences in mouse inhalant and injectable anesthesia, peri-anesthetic monitoring, specific procedures, and treating common complications. The purpose of this review article is to discuss the science of mouse anesthesia together with the art of applying these anesthetic techniques to provide readers with the knowledge needed for successful anesthetic procedures. As an old saying goes, anesthesia is 99% boredom and 1% sheer terror.
![]() Properly induced and maintained general anesthesia with effective monitoring is vital to maintaining animal welfare and creating reproducible studies. Given the range of anesthetic protocols utilized in mouse studies and the variations of experience and training in mouse anesthesia for both veterinarians and researchers, we sought in this paper to provide readers with fundamental mouse general anesthesia insight and practical mouse anesthetic protocols tailored for research use.General anesthesia may be used for surgical and non-surgical procedures and is also referred to as surgical anesthesia. Additionally, veterinarians and researchers may be reluctant to utilize alternative anesthetic drugs, in effect limiting the potential anesthetic regimes. While useful, misinterpretation of anesthesia protocols and concepts is a common occurrence. Commonly, knowledge regarding anesthesia in the research community is passed through peer-to-peer training, including veterinarians and researchers. The wide spectrum of anesthetic experience for animal care and research personnel poses challenges for institutions responsible for training individuals of various skill levels on safe anesthetic delivery to mice. DubstepThe animal is generally unaware of its surroundings but, contrary to unconsciousness, can be aroused and stimulated by noxious stimuli.Hypnosis: artificially induced sleep or trance from which an animal can be readily aroused.Tranquilization: a state in which animal is relaxed and non-anxious but is aware of its surroundings.Much of our mouse anesthesia knowledge is derived from our anesthesia knowledge of humans and larger animals as the mechanisms are similar across species. DefinitionsUnconsciousness: lack of awareness and perception of an animal’s surroundings.Immobility/muscle relaxation: the inability to move where the muscles lay in a non-tensed loose state.Analgesia: absence of pain in response to a noxious or painful stimulus.Amnesia: inability to recall events or an experience.Sedation: a state of central depression where the animal is drowsy and relaxed to some degree. Sedation, hypnosis, and tranquilization are frequently used terms when discussing anesthesia, but are specific terms separate from the 4 main general anesthesia components. There are 4 main general anesthesia components: unconsciousness, amnesia, immobility/muscle relaxation, and analgesia. 4, 5, 9–11 Though we have a limited ability to assess amnesia in animals, previous studies have shown amnesia secondary to anesthesia in a variety of animal species, including mice, 12, 13 rats, 13, 14 and zebrafish. In addition to an anesthetic’s ability to alter consciousness, anesthetics impact memory (ie, cause amnesia). 7 This indicator is used across animal species 8 and is especially useful in mice. 3–5 In animals, loss of movement (ie, movement to avoid a noxious stimulus) and the righting reflex is often used as an indicator of unconsciousness in anesthetized animals 6 and is closely correlated with human loss of consciousness. ![]() A nociceptive stimulus (injuries or surgeries) activates nociceptors (transduction). A pain pathway graphic summary, including its major components. This is discussed further in the next section and has been summarized in Figure 1.The pain pathway. At a high enough concentration, this disruption suppresses the spinal reflexes, thus preventing movement. The ability of an anesthetic to cause immobility comes from disruption of action along this pathway and varies by the anesthetic drug utilized. §, Indicates the drug suppresses the perception of pain (due to a surgical anesthesia plane) but does not provide analgesia. *, Indicates the analgesic has both a standard and long-acting formulation available. Commonly used analgesics are identified at their pain pathway action sites. Sufficient pain signals up-regulation, causing stimulus information to travel up the nervous system to the brain where pain perception occurs in conscious animals (perception). Generally, NMBAs are infrequently associated with mouse anesthesia, but when needed their use must be approved by the Institutional Animal Care and Use Committee (IACUC), written in the research protocol, and frequently requires a scientific justification. Due to their skeletal muscle action, NMBAs can be useful with certain types of surgery (ie, thoracotomy) to relax muscles however, intubation and ventilation (mechanically or manually) is mandatory. NMBA reversal proceeds in the opposite direction. These agents cause profound muscle relaxation at first peripherally and progressing centrally, with the diaphragm affected last. 19 Their use must include surgical anesthesia so patients are unaware of the paralytic state. Neuromuscular Blocking AgentsNeuromuscular blocking agents (NMBAs), also known as muscle relaxers or paralytics (eg, d-tubocurarine, atracurium, succinylcholine), produce immobility but not unconsciousness and can mask signs of pain, distress, or general anesthesia emergence. Typical Charges For Anesthesia Office Skin Incision AndAs discussed, at a sufficiently high dose, anesthetics will render an animal unconscious, thus preventing the perception of noxious stimuli (ie, pain). Experiencing pain, mentioned above, is a conscious perception of noxious stimuli this pathway has been summarized in Figure 1. AnalgesiaAnalgesia is vital to both effective anesthesia and animal welfare. During the paralytic period, the animal requires continuous monitoring for signs of pain or distress (eg, heart rate, respiratory rate , blood pressure) using baseline measurements, ideally starting from the time of the skin incision. Furthermore, NMBA administration is to occur after the skin incision and should be confined exclusively to the point of the procedure where needed. Generally, this involves demonstrating the anesthetic technique’s adequacy without NMBAs. Video editing software for mac powerpc19–21 Although an anesthetized animal is not consciously perceptive of pain, it should be noted that stimuli such as surgical manipulations can yield physiologic changes, such as elevated blood pressure, increased heart rate, 8, 22 and brain activity changes.
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