Usefulness of a virtual reality educational program for reducing preoperative anxiety in children: A randomised, single-centre clinical trial.

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.

Preoperative anxiety in the paediatric population in a tertiary hospital: A descriptive cross-sectional study.

AIM: To analyse preoperative paediatric anxiety in a tertiary hospital and influencing factors. DESIGN AND METHODS: This study was designed as a descriptive cross-sectional study. One hundred patients between two and 12 years old who underwent elective surgical intervention were included. All patients received oral or written information about the anaesthetic-surgical process and waited in a playroom before surgery. Preoperative paediatric anxiety was assessed using the modified Yale Preoperative Anxiety Scale and its short form. Collaboration during anaesthesia induction was evaluated using the Induction Compliance Checklist and postoperative pain evaluated using Wong-Baker Scale. We performed a descriptive and comparative analysis of the results overall. RESULTS: We found a high incidence of preoperative anxiety, especially during anaesthetic induction. Children aged two to five years, female sex and otorhinolaryngology surgery were associated with a higher incidence of preoperative anxiety. CONCLUSIONS: Providing oral and written information and waiting in the playing room before surgery are insufficient measures to prevent preoperative paediatric anxiety.