Related Experiment Video
Updated: Jun 18, 2026
Virtual Reality Experiments with Physiological Measures
Published on: August 29, 2018
Use of Virtual Reality in the Pediatric Perioperative Setting and for Induction of Anesthesia: Mixed Methods Pilot
Yu Tong Huang1,2, Sofia Addab1,2, Gianluca Bertolizio3
1Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.
Insights
Virtual reality (VR) shows promise for reducing pediatric surgical anxiety. While well-tolerated and useful, implementation challenges exist during anesthesia induction and in the waiting room.
Area of Science:
- Pediatric Anesthesiology
- Medical Technology Integration
- Patient Experience Research
Background:
- Children frequently experience significant anxiety before surgery, which can lead to negative postoperative outcomes.
- Virtual reality (VR) is an emerging technology with demonstrated potential for alleviating anxiety and pain during medical procedures.
- Prior studies confirm VR's effectiveness in reducing preoperative anxiety in children during the waiting period and anesthesia induction.
Purpose of the Study:
- To assess the feasibility of using virtual reality (VR) for anxiety reduction throughout the entire perioperative period, from waiting room to anesthesia induction.
- To evaluate the clinical utility, patient tolerability, and initial efficacy of VR intervention in pediatric surgical patients.
- To identify potential barriers and facilitators for implementing VR in the perioperative setting.
Main Methods:
- A mixed-methods feasibility trial involving 39 pediatric patients undergoing elective surgery under general anesthesia (GA).
- Participants utilized interactive VR from the waiting room through anesthesia induction, with feasibility assessed by intervention duration and interruptions.
- Clinical utility, tolerability (Child Simulator Sickness Questionnaire), and efficacy (anxiety/pain scales, Induction Compliance Checklist, Pediatric Anesthesia Emergence Delirium scale) were measured using questionnaires and validated scales.
Main Results:
- Patients, parents, and healthcare providers were receptive to VR use.
- While generally satisfied and finding VR tolerable with no simulator sickness, significant feasibility barriers were noted, including frequent interruptions (92%) by staff and delays.
- VR use continued through transport in 49% of patients, with 15% induced under VR; however, mask seal and positioning issues led to discontinuation in some cases.
Conclusions:
- Virtual reality (VR) demonstrates considerable clinical utility and is well-tolerated for pediatric patients in the perioperative setting.
- Significant organizational and technical challenges hinder the widespread feasibility of VR, particularly during anesthesia induction and in the waiting room.
- Addressing these identified barriers is crucial for the successful integration and implementation of perioperative VR in pediatric care.
Background:
Children commonly experience high levels of anxiety prior to surgery. This distress is associated with postoperative maladaptive behaviors. Virtual reality (VR) is an innovative tool for reducing anxiety and pain during various medical procedures. Previous randomized controlled trials have demonstrated its efficacy in reducing children's anxiety in the preoperative waiting room or during induction.
Objective:
The primary aim of this study was to examine the feasibility of VR distraction throughout the perioperative period, from the waiting room until the induction of general anesthesia (GA). Secondary aims were to assess its clinical utility, tolerability, and initial clinical efficacy.
Methods:
A mixed methods, concurrent triangulation feasibility trial was piloted at the Shriners Hospitals for Children-Canada. Participants played an interactive VR game throughout the perioperative period, starting from the waiting room until induction. Feasibility was examined with the duration of the VR intervention, recording the number of interruptions, and taking field notes. Clinical utility was assessed using a perception questionnaire. Tolerability was evaluated by the Child Simulator Sickness Questionnaire (CSSQ). Initial clinical efficacy was assessed by the Faces Pain Scale-Revised, Faces Anxiety Scale, Graphic Rating Scale for multidimensional pain, the Induction Compliance Checklist, and the Pediatric Anesthesia Emergence Delirium scale. Quantitative data were supported with field notes and semistructured interviews with patients and parents. Quantitative and qualitative themes were compared via the triangulation protocol to produce final themes.
Results:
A total of 39 patients, with a mean age of 11.9 (SD 2.8) years, undergoing elective surgery under GA participated in the study. Stakeholders, including patients, parents, and health care providers, were receptive and willing to adapt to VR. Of the 39 patients, 19 (49%) continued to use VR during transportation and 6 (15%) were induced with VR. Barriers to feasibility included (1) interruptions to VR in 92% (36/39) of patients by health care professionals, (2) unpredictable surgery delays prolonging the duration of the VR intervention (mean 23.1, SD 24.4 minutes; range 5-150 minutes), and (3) discontinuation of VR before induction due to mask seal (n=3) and discomfort with supine positioning (n=2). Patients were generally satisfied with VR, deemed it acceptable and easy to use, and would recommend it to others. VR was tolerable with no self-reported simulator sickness (CSSQ: mean 0.01, SD 0.1). The mean Faces Anxiety Score was 1.5 (SD 1.1) at baseline and 0.7 (SD 0.9) during VR.
Conclusions:
While VR demonstrated good clinical utility and was well tolerated in the broad perioperative setting, this study highlighted important feasibility barriers in the waiting room and especially during induction of anesthesia, both at the organizational and technical levels. This study highlights several considerations that should be carefully addressed for the successful implementation of perioperative VR.
