Comparison of Aqueous and Alcohol-based Agents for Presurgical Skin Preparation Methods in Mice

Evaluation of Active Warming and Surgical Draping for Perioperative Thermal Support in Laboratory Mice

Surgical procedures are commonly performed using mice but can have major effects on their core body temperature, including development of hypothermia. In this study, we evaluated active perioperative warming with and without surgical draping with adherent plastic wrap to refine practices, improve animal welfare, and optimize research experiments. Mice were randomized into treatment groups (n = 6; 8 CD1 mice per group). Treatments included placement within a small-animal forced-air incubator at 38 ° C for 30 min before surgery (Pre), after surgery (Post), or before and after surgery (Both). To explore the effect of surgical draping, one group received incubator warming before and after surgery in addition to surgical draping (Both/ Drape), whereas another group received surgical draping only without incubator warming (Control/Drape). The final group of mice received neither warming nor draping (Control). Subcutaneous temperature transponders were placed in all mice. Approximately 5 d after transponder placement, mice were anesthetized with ketamine-xylazine and underwent laparotomy. Subcutaneous body temperatures were collected perioperatively from transponders, and rectal temperatures were taken every minute during surgery. For recovery from anesthesia, mice were placed either in a standard cage on a warm water blanket set to 38 °C (100.4 °F) or in the incubator. Subcutaneous body temperatures were significantly higher in mice prewarmed for 30 min (Pre, Both, Both/Drape) as compared with mice that were not prewarmed. Anesthetic recovery times were significantly longer for mice placed in the incubator (Pre, Post, Both, Both/Drape) than for those that did not receive incubator warming (Control, Control/Drape). Mean intraoperative rectal temperatures of Both/Drape mice tended to be greater than those of mice in the Both group, suggesting a warming benefit of surgical draping. Using a forced air incubator and adherent plastic draping mitigated body temperature loss in mice during both surgery and postoperative recovery.

Preoperative skin asepsis protocols using chlorhexidine versus povidone-iodine in veterinary surgery: A systematic review and meta-analysis

OBJECTIVE

To provide a systematic assessment of the efficacy of preoperative skin asepsis using chlorhexidine versus povidone-iodine based protocols for surgical site infection (SSI) prevention in veterinary surgery.

STUDY DESIGN

Systematic meta-analytical review according to PRISMA-P guidelines.

SAMPLE POPULATION

Studies comparing preoperative skin asepsis protocols using chlorhexidine versus povidone-iodine in veterinary surgery identified by systematic search between 1990 and 2020.

METHODS

A search using MEDLINE/Pubmed, Web of Science and CAB Abstracts was performed, followed by secondary searches of Google Scholar, Proquest Dissertation and Theses, and relevant bibliographic articles. Primary and secondary outcome measures were the efficacy of skin asepsis protocols using chlorhexidine versus povidone-iodine on SSI incidence and skin bacterial colonization, respectively. A meta-analysis was performed with a random-effect model, with effect size calculated as risk ratio (RR) or mean standard deviation (MSD) with 95% CI. Statistical significance was set at P < .05.

RESULTS

Among 1067 publications that met the initial search criteria, 9 relevant studies were eligible for analysis. No difference in the incidence of postoperative SSI or skin bacterial colonization between preoperative asepsis protocols using chlorhexidine versus povidone-iodine was found. Insufficient information and detail were frequent among studies and precluded a clear assessment of bias.

CONCLUSION

This study showed that asepsis protocols using chlorhexidine were comparable to povidone-iodine in preventing postoperative SSI and reducing skin bacterial colonization.

CLINICAL SIGNIFICANCE

Given the limitations of the studies that were included in terms of both quality and quantity, more high-quality randomized controlled trials are needed to confirm these conclusions.

The Effect of Different Preoperative Depilation Ways on the Healing of Wounded Skin in Mice

Simple Summary

An increasing number of animals, including pets, may undergo surgery due to diseases or cesarean section nowadays. To reduce surgical site infection, hair removal is a necessary step before the surgical procedure because of the dense hair layer on the skin. However, previous studies showed that inappropriate hair removal methods might even increase surgical site infection rates. Although there are many commonly used preoperative depilation methods, it still has no detailed, unified selection criteria for animal preoperative hair removal. Therefore, we intend to provide a scientific and practical reference for veterinarians. To explore more specific details on whether depilation affects the condition of a surgical site, we established a skin wound model after the depilation step and then compared four commonly used hair-removal methods through morphological assessment and histopathological analysis. Ultimately, we concluded that the electric shaving method is the best method for preoperative depilation, followed by the depilatory cream method, and the sodium sulfide aqueous solution depilation method is the worst. We hope that the results of this study can provide useful reference points for veterinarians and researchers and help refine surgical procedures and maintain animal welfare.

Abstract

Hair removal is necessary before operating on animals with dense hair layers. To provide an appropriate hair removal method and maintain animal welfare, we introduced four commonly used depilation methods—namely, scissors shearing, electric shaving, depilatory cream, and sodium sulfide, and made systematic comparisons, instead of only examining one or two methods, as reported in the past. To further assess convenience and possible effects on skin wound healing, we performed a skin trauma model after depilation in C57BL/6J mice and recorded wound healing time. Meanwhile, the skin tissues around the wound were stained with H&E and Masson. The results showed that the wound contraction rate of the sodium sulfide group was significantly lower than other groups at different points in time. Furthermore, depilatory cream and sodium sulfide methods could induce a topical inflammatory response on the third day after the operation and delay the regeneration of collagen fibers. We concluded that sodium sulfide depilatory has a significant negative effect on wound healing. Depilatory cream is gentler, with mild skin irritation and symptoms of inflammation. The electric shaving method is more convenient and safer, and thus could be the best choice for preoperative depilation.

The Effectiveness of Hot Bead Sterilization in Maintaining Sterile Surgical Instrument Tips across Sequential Mouse Surgeries

One strategy commonly employed for rodent surgeries is a "tips-only" surgical technique, which restricts the surgeon to using only the sterile working ends of the surgical instruments to manipulate the surgical field and sterilizes instrument tips with a hot bead sterilizer between consecutive rodents. Despite the common use of the "tips-only" technique, research is lacking on the number of sequential surgeries for which the same set of hot bead-sterilized instruments can be used before introducing bacterial contamination. We performed serial mouse surgeries using the "tips-only" technique under 3 different conditions (aseptic, fur contamination, or cecal contamination) and assessed aerobic bacterial growth before and after each round of hot bead sterilization. Instrument tips showed an increasing probability of contamination of at least one instrument in a series of consecutive surgeries. The probability that all surgical instrument tips in the series were sterile after hot bead sterilization fell by 4% for each surgery involving inadvertent or fur contamination and by 11.5% for each surgery with contamination for all surgical types combined (including entering the gastrointestinal tract). Based on our results, hot bead sterilization is not adequate for surgeries associated with gross contamination. Under our experimental conditions and assuming independence of outcomes between consecutive surgeries, up to 5 surgeries associated with minor or inadvertent contamination could be performed in series with a probability higher than 80% that all instrument tips were sterile for all surgeries. A case-by-case risk assessment should be conducted to derive institutional guidelines for the maximal number of surgeries that can be performed in sequence using the "tips-only" technique with hot bead sterilization of the same set of surgical instruments between surgeries. Full sterilization of instruments after every surgery provides the greatest confidence in maintaining sterility.

Using Waterless Alcohol-based Antiseptic for Skin Preparation and Active Thermal Support in Laboratory Rats

Rodents are frequently used for models that require surgical procedures. At our institution, laboratory rats are increasingly preferred for investigations of neurologic disorders, cardiovascular interventions, and assessment and treatment of addictive and depressive behaviors. For these types of studies, surgical preparations of the head and neck areas are necessary for catheterization and instrumentation. Based upon our former work in laboratory mice, we sought to improve rat surgery outcomes and confirm the efficacy of a waterless alcohol-based (WAB) antiseptic for skin disinfection prior to incision. In addition, we wanted to investigate whether active warming efforts improved perioperative body temperatures for rats to aid in return to consciousness. Prior to cranial surgical incision and placement in stereotactic equipment, rats were assessed after skin preparation with WAB and after thermal interventions, including prewarming cages for 30 min before anesthesia and delivery of warmed fluid (NaCl) supplementation. Core temperatures were recorded and aerobic culture swabs collected from surgical sites at multiple time points. As previously shown in mice, bacterial counts in rats were effectively diminished by WAB agents. Assessment of intraoperative body temperature trajectories did not identify appreciable differences between control rats and rats that were exposed to prewarming or warmed fluid supplementation or both. However, heavier male rats recovered more rapidly from isoflurane anesthesia than did lighter male and female rats. Although these thermal support measures did not significantly improve anesthetic recovery times in rats, animals warmed for 30 min trended toward a faster return to righting reflex after exposure to isoflurane. These findings confirm that WAB antiseptic is an acceptable option for skin preparation in rats and suggest that continued evaluation of thermal interventions remains of interest for improved outcomes in rat surgery.

Comparison of the effect of isopropyl alcohol and chlorhexidine solution rinses on body temperature of female cats undergoing sterilization surgery

OBJECTIVES

Isopropyl alcohol 70% as a rinse agent for chlorhexidine scrub has been shown to decrease body temperature more quickly than chlorhexidine solution in mice prepared aseptically prior to surgery. For this reason, some high-quality, high-volume (HQHV) surgical sterilization clinics use chlorhexidine solution rather than alcohol. We sought to determine if temperature upon entry to recovery, heat loss per kg and rate of temperature decline during surgery were different between cats rinsed with chlorhexidine solution vs 70% isopropyl alcohol following surgical scrub, and if there were significant predictors of recovery temperature.

METHODS

Female cats admitted for surgery to trap-neuter-return (TNR) clinics at a veterinary college were assigned chlorhexidine solution or alcohol rinse agents via block randomization. Veterinary students and veterinarians performed spay surgeries using HQHV techniques. In recovery, heat support and reversal agents were available for cats with a low body temperature or that were slow to recover. Baseline values, outcome variables and duration of each stage (preparation, surgery, recovery) were assessed using Wilcoxon rank-sum and t-tests. Recovery temperature was evaluated using random effects multiple linear regression.

RESULTS

The recovery temperature, heat loss per kg, heat loss per min, need for reversal and need for heat support in recovery were not significantly different between rinse groups. Weight <2.3 kg, body condition score <4, duration of surgery and postinduction temperature were predictors of recovery temperature. The rate of heat loss in the first 30 mins of surgery was slightly lower for cats in the alcohol rinse group and the recovery duration was shorter for cats weighing less <2.3 kg in the alcohol rinse group.

CONCLUSIONS AND RELEVANCE

There were no clinically meaningful differences in body temperature between chlorhexidine and alcohol rinses. Both chlorhexidine solution and isopropyl alcohol 70% are appropriate rinse agents for aseptic preparation of feline spay surgeries.

Nonexperimental Xenobiotics: Unintended Consequences of Intentionally Administered Substances in Terrestrial Animal Models

Review of the use of nonexperimental xenobiotics in terrestrial animal models and the potential unintended consequences of these compounds, including drug-related side effects and adverse reactions.

Evaluation of 3 Alcohol-based Agents for Presurgical Skin Preparation in Mice

Appropriate aseptic technique is a crucial component of rodent survival surgery. Ease of technique, surgical space constraint, batch surgery, and cost are factors that may affect researcher compliance with appropriate aseptic technique. The first part of this study compared 3 antiseptic preparation agents with the standard triplicate application of povidone-iodine and alcohol. Euthanized mice (n = 40) were shaved on the dorsum, and culture swabs were taken for RODAC plating and bacterial identification. Shaved sites were prepared by using one of the 4 antiseptic preparation agents. Culture samples were obtained immediately and at 20 min after antiseptic preparation. In the 2nd part of the study, 8 mice (n = 2 per group) were prepared for a survival surgical procedure by using one of the 4 antiseptic preparation agents to evaluate whether the antiseptic preparation agents caused skin irritation or impaired healing. Results from this study indicated that all 3 of the antiseptic agents evaluated were equally effective at reducing bacterial populations immediately and at 20 min after preparation. Histopathologic examination of the incision sites revealed signs of normal healing without lesions adjacent to the incision site. We conclude that all 3 of the products evaluated are comparable to traditional povidone-iodine and alcohol as agents for aseptic preparation of surgical sites.