(28) Keep Calm and Infuse On: Evaluating the Use of Dexmedetomidine Anxiolysis during I-131 MIBG Therapy

Title: Keep Calm and Infuse On: Evaluating the Use of Dexmedetomidine Anxiolysis during I-131 MIBG Therapy

Abstract : I-131 MIBG therapy is an effective treatment for high-risk neuroblastoma but exposes caregivers to ionizing radiation. Managing patient anxiety and agitation during therapy is crucial for safety and reducing caregiver radiation exposure. Dexmedetomidine has shown potential as an anxiolytic in this setting but is underexplored. The purpose of this project was to describe the feasibility and nurse acceptability of dexmedetomidine anxiolysis during I-131 MIBG therapy. A retrospective chart review of pediatric patients who received dexmedetomidine anxiolysis over six months was conducted. Feasibility was assessed by analyzing adverse events, vital sign changes, dose adjustments, and radiation exposure to caregivers. Nurse acceptability was evaluated using a questionnaire based on the Theoretical Framework of Acceptability and focus group. All patients (n = 7) received the full I-131 MIBG dose with dexmedetomidine anxiolysis with no adverse events reported. Vital sign changes were minor and transient. Radiation exposure to caregivers was well below 10% of the federal annual dose limit for occupational radiation workers. Nurse (n = 10) feedback indicated high acceptability, with 100% reporting that dexmedetomidine was easy to administer, contributed to patient safety, and effectively supported the safe administration of MIBG. Additionally, 90% of nurses considered dexmedetomidine to be an acceptable form of anxiolysis for patients receiving I-131 MIBG therapy. Focus group discussions revealed challenges with intravenous access and the need for enhanced interdisciplinary communication. Three practice changes were implemented: multidisciplinary pre-admission huddles, bedside huddles for clinical concerns, and a standardized dexmedetomidine administration protocol. Dexmedetomidine anxiolysis is a feasible and acceptable option for pediatric patients receiving I-131 MIBG therapy, effectively supporting radiation safety without compromising care. This project underscores the importance of multidisciplinary collaboration and nurse feedback in refining clinical practice. Future work should evaluate dexmedetomidine anxiolysis in a larger sample and in other hospital settings.