The effect of an immersive virtual reality tour of the operating theater on emergence delirium in children undergoing general anesthesia: A randomized controlled trial

Abstract

Summary Background and Aims An immersive virtual reality tour of the operating theater could reduce preoperative anxiety. This study was designed to determine whether a preoperative immersive virtual reality tour demonstrates a reduction in emergence delirium through reducing the preoperative anxiety in children undergoing general anesthesia. Methods Eighty‐six children were randomly allocated into either the control or virtual reality group. The control group received conventional education regarding the perioperative process. The virtual reality group watched a 4‐minute virtual reality video showing the operating theater and explaining the perioperative process. Incidence and severity of emergence delirium were the main outcomes. Secondary outcomes included preoperative anxiety using modified Yale Preoperative Anxiety Scale and postoperative behavioral disturbance. Results Eighty children completed the final analysis (control group = 39, virtual reality group = 41). The incidence (risk ratio [95% CI]: 1.1 [0.5‐2.8], P = 0.773) and severity of emergence delirium (mean difference [95% CI]: −0.2 [−2.7 to 2.2], P = 0.791) were similar in the two groups. After the intervention, children in the virtual reality group had a significantly lower modified Yale Preoperative Anxiety score than those in the control group (mean difference [95% CI]: 9.2 [0.3‐18.2], P = 0.022). No difference was observed regarding postoperative behavioral disturbance between the two groups at postoperative 1 day (mean difference [95% CI]: −0.1 [−0.3 to 0.1], P = 0.671) and 14 day (mean difference [95% CI]: −0.0 [−0.1 to 0.0], P = 0.329). Conclusion Preoperative immersive virtual reality tour of the operating theater did not reduce the incidence and severity of emergence delirium, although it was effective in alleviating preoperative anxiety in children.

The Effect of Virtual Reality on Preoperative Anxiety: A Meta-Analysis of Randomized Controlled Trials

“…In the remaining 18 articles, the full texts were examined and among them, eight articles were excluded from the analysis due to the following reasons: no full-length articles ( n = 4), patients experienced VR during surgery ( n = 1), healthy subjects ( n = 1), non-randomized trial ( n = 1), and patients in both groups experienced VR ( n = 1). Finally, a total of 10 RCTs were included in this meta-analysis ( Figure 1 ) [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. Among them, seven studies included two groups (VR group and control group) [ 21 , 22 , 23 , 27 , 28 , 29 , 30 ], while three studies included multiple groups [ 24 , 25 , 26 ].…”

“…The preoperative anxiety score was measured and reported in 10 RCTs, including 813 patients [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. It was measured with various tools, including modified Yale Preoperative Anxiety Scale [ 23 , 27 , 28 , 29 ], Yale Preoperative Anxiety Scale [ 22 ], Amsterdam Preoperative Anxiety and Information score [ 21 , 30 ], Hospital Anxiety and Depression Scale [ 26 ], Visual Analogue Scale [ 25 ], or Numeric Rating Scale [ 24 ]. A high score corresponded to a high level of anxiety in 9 RCTs [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ], whereas it was associated with a low level of anxiety in 1 RCT [ 21 ].…”

“…It was measured with various tools, including modified Yale Preoperative Anxiety Scale [ 23 , 27 , 28 , 29 ], Yale Preoperative Anxiety Scale [ 22 ], Amsterdam Preoperative Anxiety and Information score [ 21 , 30 ], Hospital Anxiety and Depression Scale [ 26 ], Visual Analogue Scale [ 25 ], or Numeric Rating Scale [ 24 ]. A high score corresponded to a high level of anxiety in 9 RCTs [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ], whereas it was associated with a low level of anxiety in 1 RCT [ 21 ]. Therefore, we multiplied the mean values from a given study by “−1” to ensure that all the scales were moving in the same direction, according to the Cochrane guidelines [ 18 ].…”

“…Therefore, we multiplied the mean values from a given study by “−1” to ensure that all the scales were moving in the same direction, according to the Cochrane guidelines [ 18 ]. The preoperative anxiety scores were presented as the means with SD in two RCTs [ 24 , 25 ], median with interquartile range in four RCTs [ 23 , 27 , 28 , 30 ], and mean difference with 95% CI between two groups in two RCTs [ 21 , 29 ]. Robertson et al [ 26 ] presented the change in scores, from baseline to post-intervention, without baseline values.…”

Reducing Anxiety for Dental Visits

“…This is particularly useful for children who often find the unfamiliar sights, sounds and equipment inside dental clinics unsettling. Virtual tours [6] and gamification [7] have been shown to successfully improve experiences for children undergoing operations under general anaesthetic.…”