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Virtual reality in preoperative preparation of children undergoing general anesthesia: a randomized controlled study

Virtuelle Realität in der präoperativen Vorbereitung von Kindern unter Vollnarkose: eine randomisierte kontrollierte Studie

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Preoperative anxiety can cause hyperalgesia, postoperative delirium and other adverse events, and even long-term psychological disorders. The aim of this trial was to determine whether preoperative virtual reality (VR) preparation reduces anxiety prior to induction of anesthesia.


Data were analyzed for 99 children undergoing elective surgery. Participants were randomly assigned to a VR exposure intervention group or a control group. In the VR group, children watched a VR video showing a realistic interactive immersive virtual version of the perioperative process. The control group received conventional preoperative preparation. Preoperative anxiety using the modified Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF) during anesthesia induction was the main outcome. Secondary outcomes included induction compliance, emergence delirium, pain, and parental satisfaction.


The VR group had lower mYPAS-SF scores when leaving the waiting area (27.1, interquartile range, IQR 22.9–33.3 vs. 33.3, IQR 27.1–39.6; P = 0.006), and during anesthesia induction (29.2, IQR 22.9–33.3 vs. 39.6, IQR 33.3–55.2; P = 9×10−6). The Induction Compliance Checklist (ICC) scores during anesthesia induction were lower in the VR group (0.0, IQR 0.0–0.0 vs. 1.0, IQR 0.0–1.0; P = 0.003) than the control group, while parental satisfaction in the VR group was higher.


Virtual reality exposure as a preparation tool has a beneficial effect on anxiety, induction compliance and parental satisfaction in children undergoing elective surgery.

Clinical trial registration




Präoperative Angst kann Hyperalgesie, postoperatives Delirium und andere unerwünschte Ereignisse und sogar langfristige psychische Störungen verursachen. Ziel dieser Studie war es, festzustellen, ob eine präoperative Vorbereitung mithilfe virtueller Realität (VR) die Angst vor der Narkoseeinleitung reduziert.


Es wurden die Daten von 99 Kindern analysiert, die sich einer elektiven Operation unterzogen. Die Teilnehmer wurden nach dem Zufallsprinzip einer VR-Interventionsgruppe oder einer Kontrollgruppe zugewiesen. In der VR-Gruppe sahen die Kinder ein Virtual-Reality-Video, das eine realistische, interaktive und immersive virtuelle Version des perioperativen Prozesses zeigte. Die Kontrollgruppe erhielt eine konventionelle präoperative Vorbereitung. Das Hauptergebnis war die präoperative Angst während der Narkoseeinleitung anhand der modifizierten Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF). Zu den sekundären Ergebnissen gehörten die Compliance bei der Einleitung, das Delirium beim Aufwachen, die Schmerzen und die Zufriedenheit der Eltern.


Die VR-Gruppe hatte niedrigere mYPAS-SF-Werte beim Verlassen des Wartebereichs (27,1 [22,9–33,3] vs. 33,3 [27,1–39,6]; p = 0,006) und während der Narkoseeinleitung (29,2 [22,9–33,3] vs. 39,6 [33,3–55,2]; p = 9×10−6). Die ICC-Scores während der Narkoseeinleitung waren in der VR-Gruppe niedriger (0,0 [0,0–0,0] vs. 1,0 [0,0–1,0]; p = 0,003) als in der Kontrollgruppe, während die Zufriedenheit der Eltern in der VR-Gruppe höher war.


Die Erfahrung mit dem Vorbereitungsprozesses mittels VR wirkt sich positiv auf die Angst, die Compliance und die Zufriedenheit der Eltern bei Kindern aus, die sich einer elektiven Operation unterziehen.

Registrierung der klinischen Studie


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We wish to thank the anesthesiologists, nurse anesthetists and recovery nurses for their cooperation and help with data collection. We thank Diane Williams, PhD, from Liwen Bianji (Edanz) ( for editing the English text of a draft of this manuscript.


Financial support and sponsorship: this research was funded by Health Commission of Zhejiang Province (project number: 2020KY759). The authors report no involvement in the research by the sponsor that could have influenced the outcome of this work.

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Correspondence to Huiyue Feng.

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Yijie Wu, Junjun Chen, Wenlu Ma, Lili Guo and Huiyue Feng declare that they have no competing interests.

This study was approved by the institutional review board of Hangzhou Children’s Hospital on 21 October 2019 and was registered in the Chinese Clinical Trial Registry (ChiCTR2000035417). Informed consent was obtained from all individual participants included in the study.

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Wu, Y., Chen, J., Ma, W. et al. Virtual reality in preoperative preparation of children undergoing general anesthesia: a randomized controlled study. Anaesthesiologie 71 (Suppl 2), 204–211 (2022).

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