title: Extended Sedation With Continuous Midazolam or Dexmedetomidine Infusion for Young Children Receiving 131 I-MIBG Radiopharmaceutical Therapy for Advanced Neuroblastoma.
abstract: BACKGROUND
  (131) I-MIBG is increasingly used for treating neuroblastoma; however, administration requires careful adherence to radiation safety guidelines. We describe our experience using continuous sedation to facilitate safe (131) I-MIBG therapy for young children.
  
  
  METHODS
  Patients were included in this case series if they received continuous midazolam or dexmedetomidine infusion for sedation during (131) I-MIBG therapy from November 1, 2012, to October 1, 2014. Key outcomes included adequacy of sedation for both (131) I-MIBG infusion and the duration of radioactive isolation, as well as sedative-related toxicities. Additionally, nuclear medicine scans before and after (131) I-MIBG therapy were assessed using the Curie score. These scores were compared qualitatively between midazolam, dexmedetomidine, and control (no sedative infusion) groups.
  
  
  RESULTS
  Of the 13 patients receiving continuous sedation for (131) I-MIBG therapy, seven achieved adequate sedation with midazolam, five achieved adequate sedation with dexmedetomidine, one patient (1.6 years old) failed to achieve adequate sedation with either medication and did not receive (131) I-MIBG therapy. Sedation was generally well tolerated. Common side effects for dexmedetomidine infusion included hypotension and relative bradycardia. Both treatment and control groups had multiple patients with increased Curie scores post-(131) I-MIBG therapy. However, one patient in the midazolam group and two in the dexmedetomidine group had decreased Curie scores after (131) I-MIBG therapy, while none decreased in the control group.
  
  
  CONCLUSIONS
  Although we cannot exclude the possibility of some inhibition of (131) I-MIBG uptake by midazolam or dexmedetomidine, this case series suggests that continuous infusions of either agent can provide effective sedation to allow safe administration of (131) I-MIBG to young patients.
authors.affiliation: Department of Pediatrics, UCSF Benioff Children's Hospital San Francisco, University of California San Francisco, California.
authors.forename: Jean S
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Department of Radiology and Biomedical Imaging, Division of Nuclear Medicine, UCSF Medical Center, University of California San Francisco, California.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Wu
authors.affiliation: Department of Pediatrics, Division of Hematology/Oncology, UCSF Benioff Children's Hospital San Francisco, University of California San Francisco, California.
authors.forename: Thalia
authors.initials: T
authors.lastname: Wong
authors.affiliation: Department of Pediatrics, Division of Hematology/Oncology, UCSF Benioff Children's Hospital San Francisco, University of California San Francisco, California.
authors.forename: Steven G
authors.initials: SG
authors.lastname: DuBois
authors.affiliation: Department of Pediatrics, Division of Hematology/Oncology, UCSF Benioff Children's Hospital San Francisco, University of California San Francisco, California.
authors.forename: Katherine
authors.initials: K
authors.lastname: Matthay
authors.affiliation: Department of Pediatrics, Division of Hematology/Oncology, UCSF Benioff Children's Hospital San Francisco, University of California San Francisco, California.
authors.forename: Clay
authors.initials: C
authors.lastname: Gustafson
authors.affiliation: Department of Radiology and Biomedical Imaging, Division of Nuclear Medicine, UCSF Medical Center, University of California San Francisco, California.
authors.forename: Randall
authors.initials: R
authors.lastname: Hawkins
authors.affiliation: Department of Pediatrics, Division of Critical Care, UCSF Benioff Children's Hospital San Francisco, University of California San Francisco, California.
authors.forename: Arup
authors.initials: A
authors.lastname: Roy-Burman
mesh_terms: D019797:3-Iodobenzylguanidine / Q000008:administration & dosage* / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000379:methods; D020927:Dexmedetomidine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007223:Infant; D007262:Infusions, Intravenous / Q000379:methods; D008297:Male; D009447:Neuroblastoma / Q000532:radiotherapy*; D011724:Pyridazines / Q000008:administration & dosage*; D019275:Radiopharmaceuticals / Q000008:administration & dosage* / Q000378:metabolism
chemical_list: D006993:Hypnotics and Sedatives; D011724:Pyridazines; D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine; C048087:medazomide; D020927:Dexmedetomidine
keywords: MIBG; neuroblastoma; sedation