The Effect of the Immersion Quality and Timing of Virtual Reality Technology to Reduce Preoperative Anxiety in Pediatric Patients Before Undergoing Anesthesia Induction: A Systematic Review and Meta-analysis.

PURPOSE: Nonpharmacological intervensions, particularly Virtual Reality (VR), have emerged as a promising approach to mitigate preoperative anxiety in children. This systematic review and meta-analysis aimed to evaluate the effectiveness of VR in reducing preoperative anxiety in pediatric patients and to analyze the impact of VR immersion level and timing of exposure on outcomes.

DESIGN

Systematic review and meta-analysis.

METHODS

We conducted a systematic search of five electronic databases (PubMed, PMC, ScienceDirect, SCOPUS, and Embase) for experimental studies published up to October 31, 2023. Our search included randomized controlled trials, cohort, and case-control studies focusing on pediatric patients (1 to 18 years) undergoing elective surgery. Study quality was assessed using the Cochrane risk-of-bias tool (RoB 2). Data extraction was performed independently by two reviewers, and meta-analysis was conducted using RevMan 5.4.1 (Manufactered by Cochrane). We calculated the effect size using a standardized mean difference with a 95% confidence interval (CI) and a random-effects model. The review protocol was registered with PROSPERO (CRD42023469123).

FINDINGS: Eight studies with a total of 786 participants were included. The meta-analysis found that VR intervention was significantly more effective than conventional therapy in reducing preoperative anxiety (mean difference [MD] = -10.93, 95% CI [-14.50, -7.36], P < .00001). Subgroup analysis revealed that fully immersive VR systems (MD = -11.38, 95% CI [-21.38, -1.38], P = .03) and interventions administered closer to the time of surgery (MD = -13.77, 95% CI [-18.40, -9.15], P < .00001) yielded more favorable outcomes. The overall risk of bias was found to be low to moderate.

CONCLUSIONS

VR technology is an effective non-pharmacological intervention for managing preoperative anxiety in pediatric patients. Our findings suggest that fully immersive and late-stage VR interventions are particularly effective, providing a strong basis for clinical application.