Usefulness of a virtual reality educational program for reducing preoperative anxiety in children

BACKGROUND Preoperative anxiety (PA) is common in children and has detrimental effects on surgical outcome. Strategies based on virtual reality (VR) have recently been introduced to address this problem. OBJECTIVE This study evaluated the usefulness of a virtual reality educational program (VREP) for reducing preoperative anxiety in elective low-complexity paediatric surgery. DESIGN Randomised clinical trial. SETTING Single tertiary centre in Barcelona, Spain. Between January 2019 and June 2022. PATIENTS Children aged 3–13 years of age, American Society of Anesthesiologists (ASA) I–II, scheduled for elective low-complexity surgery were enrolled in the study. INTERVENTION Children were randomised into a control group (received oral/written information about the anaesthetic-surgical process, and patients and their parents remained in a playroom waiting for the surgery) or VREP (viewed a VR-based educational video on the surgical process, 7–10 days prior to surgery) using the MATLAB application. MAIN OUTCOME MEASURE PA using the modified Yale Preoperative Anxiety Scale (mYPAS) during separation from parents. RESULTS In total, 241 children aged 3–12 years of age were studied (120 patients with VREP and 121 controls). Randomisation eliminated the differences between the groups, except for a greater male presence in the VREP group (83.3% vs. 71.1%; P = 0.023). The mYPAS yielded was lower in the VREP group (29.2% vs. 83.5%; P < 0.001). Sex did not influence VREP-mediated decrease in PA ( P < 0.001). In turn, VREP patients were more cooperative (Induction Compliance Checklist [ICC] score 0 points vs. 2 points; P < 0.001) during anaesthesia induction, presented less delirium (Pediatric Anesthesia Emergence Delirium [PAED] score 1 point vs. 3 points; P = 0.001) on leaving the recovery room, and experienced less pain upon arrival in the hospital ward (Wong-Baker Faces Pain Rating Scale: 0-points vs. 1 point; P < 0.001). CONCLUSIONS The VREP-based prevention strategy reduced preoperative anxiety in children undergoing elective low-complexity surgery. TRIAL REGISTRATION NCT03578393.