Pediatric Nurse Practitioner Children's Minnesota Minneapolis, Minnesota, United States
Title: Using Ketamine Boluses in a United States Outpatient Clinic Setting for Naxitamab infusion in Relapsed/Refractory Neuroblastoma
Abstract : Basis of Inquiry: High risk neuroblastoma remains a challenging diagnosis to treat as long-term survival rates are around 50% 1 Antibody therapy is important in treatment of relapse/refractory (R/R) disease. Naxitamab is an anti-GD2 monoclonal antibody approved by the U.S. Food and Drug Administration for use in R/R high risk neuroblastoma limited to the bone and bone marrow2. Side effects include severe nerve pain. We have been administering Naxitamab in the outpatient setting using low-dose ketamine infusion with adequate pain management. There was opportunity for improvement and, in collaboration with the anesthesia service, transitioned to ketamine boluses. Purpose/
Objective: To present a case study of a patient with R/R high risk neuroblastoma who received ketamine boluses in an outpatient clinic during Naxitamab infusions.
Methods: One patient received ketamine boluses after previously receiving low dose ketamine infusion in the outpatient clinic. Table 1 includes standard pre-medications administered and as needed medications. Ketamine IV bolus doses were based on the publication by Castaneda, et al 3 and in collaboration with the anesthesia service. Outcomes: The three year old patient received nine doses of Naxitamab infusion in combination with chemotherapy. He initially started on low dose ketamine infusion but developed intolerable pain and hypertension so was transitioned to ketamine boluses administered by the anesthesia service. For six Naxitamab doses, he received 0.6mg/kg IV boluses of ketamine administered prior to Naxitamab infusion, 20 minutes into infusion and at the end of the infusion. With this regimen, the patient was not hypertensive, denied any pain and was intermittently awake during the infusion. Vital signs remained stable. No adverse events were reported. IV ketamine boluses can be effective when administered by the anesthesia service in a US outpatient clinic setting, improved pain management and less side effects. The patient was able to return home after each administration.
