Virtual reality in preoperative preparation of children undergoing general anesthesia: a randomized controlled study

Background: Preoperative anxiety can cause hyperalgesia, postoperative delirium and other adverse events, and even long-term psychological disorders. The aim of this trial was to determine whether preoperative virtual reality (VR) preparation reduces anxiety prior to induction of anesthesia. Methods: Data were analyzed for 99 children undergoing elective surgery. Participants were randomly assigned to a VR exposure intervention group or a control group. In the VR group, children watched a VR video showing a realistic interactive immersive virtual version of the perioperative process. The control group received conventional preoperative preparation. Preoperative anxiety using the modified Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF) during anesthesia induction was the main outcome. Secondary outcomes included induction compliance, emergence delirium, pain, and parental satisfaction. Results: The VR group had lower mYPAS-SF scores when leaving the waiting area (27.1, interquartile range, IQR 22.9-33.3 vs. 33.3, IQR 27.1-39.6; P=0.006), and during anesthesia induction (29.2, IQR 22.9-33.3 vs. 39.6, IQR 33.3-55.2; P=9x10(-6)). The Induction Compliance Checklist (ICC) scores during anesthesia induction were lower in the VR group (0.0, IQR 0.0-0.0 vs. 1.0, IQR 0.0-1.0; P=0.003) than the control group, while parental satisfaction in the VR group was higher. Conclusion: Virtual reality exposure as a preparation tool has a beneficial effect on anxiety, induction compliance and parental satisfaction in children undergoing elective surgery.