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Virtual reality exposure before elective day care surgery to reduce anxiety and pain in children: A randomised
Robin Eijlers1, Bram Dierckx, Lonneke M Staals
1From the Department of Child and Adolescent Psychiatry/Psychology (RE, BD, JMB, MHJH, JSL, EMWJU), Department of Anaesthesiology, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands (LMS), Department of Anaesthesia, ZNA Middelheim, Queen Paola Children's Hospital, Antwerp, Belgium (JMB), Dutch Craniofacial Centre (MPvdS), Department of Otorhinolaryngology and Head and Neck Surgery (MPvdS), Department of Oral and Maxillofacial Surgery (EMS), Intensive Care and Department of Paediatric Surgery, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam (RMHW), Research Institute of Child Development and Education, University of Amsterdam (EMWJU), Academic Centre for Child Psychiatry De Bascule/Department of Child and Adolescent Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands (EMWJU).
Insights
Virtual reality exposure (VRE) did not reduce pre-operative anxiety or pain in children undergoing day surgery. However, VRE did decrease the need for pain medication after more painful procedures, suggesting a potential benefit for specific surgical cases.
Area of Science:
- Pediatric Anesthesiology
- Virtual Reality in Medicine
- Child Psychology
Background:
- Pre-operative anxiety is a common issue in children undergoing surgery, often leading to adverse outcomes.
- Virtual reality exposure (VRE) is explored as a potential tool to mitigate pre-operative anxiety and improve patient experience.
- Understanding the efficacy of VRE in pediatric day care surgery is crucial for optimizing pre-anesthetic preparation.
Purpose of the Study:
- To evaluate the effectiveness of virtual reality exposure (VRE) as a pre-operative preparation tool for pediatric elective day care surgery.
- To compare anxiety, pain, and emergence delirium levels in children receiving VRE versus standard care (CAU).
- To assess the impact of VRE on the need for rescue analgesia and parental anxiety.
Main Methods:
- A randomized controlled single-blind trial was conducted involving 191 children aged 4-12 years undergoing elective day care surgery.
- Participants were randomized to receive either virtual reality exposure (VRE) or care as usual (CAU) on the day of surgery.
- Anxiety was measured using the modified Yale Preoperative Anxiety Scale (mYPAS); secondary outcomes included self-reported anxiety, pain, emergence delirium, and parental anxiety.
Main Results:
- No significant differences in anxiety levels during anesthesia induction (mYPAS) were observed between the VRE and CAU groups.
- Self-reported anxiety, pain, emergence delirium, and parental anxiety did not differ significantly between the two groups.
- Children in the VRE group required significantly less rescue analgesia (morphine) after adenoidectomy/tonsillectomy compared to the CAU group (55.0% vs. 95.7%).
Conclusions:
- Virtual reality exposure (VRE) did not demonstrate a significant benefit in reducing pre-operative anxiety, pain, or emergence delirium in children undergoing elective day care surgery.
- A clinically significant reduction in the need for rescue analgesia was observed in the VRE group following more painful procedures (adenoidectomy/tonsillectomy).
- Future research should explore VRE in children with higher anxiety levels and investigate optimal timing and duration of exposure.
Background:
Pre-operative anxiety in children is very common and is associated with adverse outcomes.
Objective:
The aim of this study was to investigate if virtual reality exposure (VRE) as a preparation tool for elective day care surgery in children is associated with lower levels of anxiety, pain and emergence delirium compared with a control group receiving care as usual (CAU).
Design:
A randomised controlled single-blind trial.
Setting:
A single university children's hospital in the Netherlands from March 2017 to October 2018.
Patients:
Two-hundred children, 4 to 12 years old, undergoing elective day care surgery under general anaesthesia.
Intervention:
On the day of surgery, children receiving VRE were exposed to a realistic child-friendly immersive virtual version of the operating theatre, so that they could get accustomed to the environment and general anaesthesia procedures.
Main Outcome Measures:
The primary outcome was anxiety during induction of anaesthesia (modified Yale Preoperative Anxiety Scale, mYPAS). Secondary outcomes were self-reported anxiety, self-reported and observed pain, emergence delirium, need for rescue analgesia (morphine) and parental anxiety.
Results:
A total of 191 children were included in the analysis. During induction of anaesthesia, mYPAS levels (median [IQR] were similar in VRE, 40.0 [28.3 to 58.3] and CAU, 38.3 [28.3 to 53.3]; P = 0.862). No differences between groups were found in self-reported anxiety, pain, emergence delirium or parental anxiety. However, after adenoidectomy/tonsillectomy, children in the VRE condition needed rescue analgesia significantly less often (55.0%) than in the CAU condition (95.7%) (P = 0.002).
Conclusion:
In children undergoing elective day care surgery, VRE did not have a beneficial effect on anxiety, pain, emergence delirium or parental anxiety. However, after more painful surgery, children in the VRE group needed rescue analgesia significantly less often, a clinically important finding because of the side effects associated with analgesic drugs. Options for future research are to include children with higher levels of anxiety and pain and to examine the timing and duration of VRE.
Trial Registration:
Netherlands Trial Registry: NTR6116.
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