Use of Virtual Reality as a Surrogate for Parental Presence During Anesthetic Induction: A Case Report

Abstract

Virtual reality (VR), a computer-generated simulation of a 3-dimensional environment, is a relatively new method of providing distraction before and during procedures. We describe the use of a VR multiuser application, Oculus Rooms, to calm an anxious 10-year-old boy during transportation to the operating room and induction of anesthesia. The use of VR could lessen the perioperative anxiety of children by maintaining a virtual child-parent connection while avoiding the potential drawbacks to having parents actually in the operating room before and during induction of anesthesia. The success of this novel technique has important implications for future clinical trials and practice.

Effectiveness of Virtual Reality Interventions for Adolescent Patients in Hospital Settings: Systematic Review

“…Detailed characteristics of the included articles (n=8) are provided in Multimedia Appendix 2. Four studies [46][47][48][49] were RCTs and 4 studies [50][51][52][53] were single-case reports. Of the RCTs, 2 studies [46,49] compared VR to standard care, 1 study [47] compared VR to standard distraction (TV, music, books), and 1 study [48] compared VR to 2 control groups-standard care and passive distraction (watching a movie).…”

“…The VR session length in half of the studies [46,[50][51][52] was between 20 and 30 minutes, in line with recommendations for VR session length [54]. The exceptions were the study with venipuncture [49], in which the session length was less than 5 minutes due to the short procedure; the palliative care study (5-10 minutes per video) [53], and the 2 studies with burn wound care [47,48], in which session length varied greatly depending on the length of time required to remove and apply dressings (2-100 minutes).…”

“…One case report with chemotherapy [51] did not measure pain or anxiety directly; the use of VR during a monthly lumbar puncture procedure (injection of intrathecal chemotherapy) reduced the amount of analgesics and anxiolytics required by the patient by approximately half compared to the amount required in the Two case reports [51,52] did not use quantitative measures. In 1 study [52], staff reported that the patient remained calm and showed no signs of distress or anxiety while using VR during transportation to the operating therapy and while being administered anesthesia. In the other study [51], the patient in palliative care reported that using VR distracted them from their pain and loneliness and had a positive impact on their mood.…”

“…There is also opportunity for greater use of VR to connect adolescents in hospital with others in real time. Gupta and colleagues [52] demonstrated the feasibility of using Oculus Rooms to connect with a parent to relieve preoperative anxiety, but there are many other situations in which hospitalized adolescents are separated from their family and peers (eg, isolation rooms, palliative care, because of visiting hours limitations or having travelled from rural and remote areas). While the use of VR headsets that use smartphones as the display and processor (eg, Samsung VR Gear) is declining due to the increase in development and affordability of all-inclusive head-mounted displays (eg, Oculus Quest 2) [86][87][88], the use of either type of head-mounted display may be well-suited for hospitalized adolescents, who could potentially use their own smartphones to connect with others in VR, if given access to reliable Wi-Fi and the right software apps.…”

State of the Art: Immersive Technologies for Perioperative Anxiety, Acute, and Chronic Pain Management in Pediatric Patients

“…We identified two case studies from the USA [52,53] and one game development study from Belgium [54]. Libaw et al described the use of AR as a distraction technique during the induction of general anesthesia in a case study of three children (mean age=8.7).…”