We have a children's hospital embedded in an academic medical center with shared pharmacy services. Our pediatric anesthesiologists are asking for pharmacy-prepared anesthesia medications in safer/more practical concentrations for neonates/small pediatric patients in the setting of OR preparation/administration errors. For example fentanyl is commercially available only as 50 mcg/mL so must be diluted to measure a 3 mcg dose.

Interested in how other hospitals that provide neonatal surgeries manage this. Are there standard dilution concentrations? Do Anesthesia providers order in advance, patient-specific or are these concentrations batched and stocked in pediatric ORs?

Specific drugs we are exploring:
Fentanyl
Ketamine
Rocuronium
Epinephrine
Atropine

They are not requesting continuous infusion syringes, though that might be one way to manage this, I have reviewed ASHP S4S and Vermont Oxford Network as resources for standard concentrations.

Appreciate any responses!
Lauren