Effects of Virtual Reality on Pre-Operative Anxiety and Induction of Anesthesia in Children and Adolescents
| Status: | Recruiting |
|---|---|
| Healthy: | No |
| Age Range: | 5 - 11 |
| Updated: | 10/21/2018 |
| Start Date: | July 20, 2017 |
| End Date: | May 2019 |
| Contact: | Vanessa Pohl, B.S. |
| Email: | vpohl@phoenixchildrens.com |
| Phone: | 602-933-4482 |
A Pilot Study to Evaluate the Efficacy of Virtual Reality on Pre-Operative Anxiety and Induction of Anesthesia in a Children's Hospital
Pain and anxiety have a direct correlation. Patients who experience anxiety are more
susceptible to feeling pain, and patients who experience pain are more likely to have a
component of anxiety associated with their pain. A common technique used by pain
psychologists to help minimize pain is distraction. Different forms of distraction include
video games, movies, music, etc. Recently, doctors and researchers around the world have
begun experimenting with Virtual Reality as a distraction technique.
A review of the use of virtual reality compared to the current standard of care may help
uncover important trends regarding anxiety, postoperative pain and analgesic use in patients
who undergo a tonsillectomy or a tonsillectomy and adenoidectomy.
susceptible to feeling pain, and patients who experience pain are more likely to have a
component of anxiety associated with their pain. A common technique used by pain
psychologists to help minimize pain is distraction. Different forms of distraction include
video games, movies, music, etc. Recently, doctors and researchers around the world have
begun experimenting with Virtual Reality as a distraction technique.
A review of the use of virtual reality compared to the current standard of care may help
uncover important trends regarding anxiety, postoperative pain and analgesic use in patients
who undergo a tonsillectomy or a tonsillectomy and adenoidectomy.
There are approximately five million pediatric surgeries performed in the United States every
year, and approximately 50% of pediatric patients experience significant stress and anxiety
before their surgery. High anxiety can result in increased postoperative pain, increased
analgesic consumption, and delayed recovery. The perception of pain can have a strong
psychological component and can increase if the patient gives the area of injury constant
attention. Thus, different distraction techniques have been utilized by pain psychologists to
take the patient's attention away from the area of injury.
Pharmacological intervention to treat preoperative anxiety in children has its own
side-effect profile. Midazolam is a common medication used parentally, nasally, or orally to
alleviate preoperative anxiety. However, there are many side-effects that are not always
preventable. Reports of 3.8% of patients having paradoxical effects from midazolam have been
documented, and delayed emergence is possible in surgeries of short duration. In addition,
midazolam can also result in critical events perioperatively, such as airway obstruction and
worsened nausea and vomiting. Non-pharmacological interventions could help avoid these
complications, however, current studies do not show a viable alternative to a pharmacological
interventions.
Virtual Reality (VR) is a technology that allows individuals to experience a virtual world.
VR initially began as a form of entertainment, but it has expanded its application into
several other areas. Within the past 10 years, this type of technology has been applied
clinically as a method of distraction for medical procedures such as chemotherapy, physical
therapy, burn wound changes, and surgery. VR allows the patients to be immersed in an
interactive world stimulating sights, sounds, and motion to help enhance the distraction from
pain, ultimately reducing anxiety. A small validation study was conducted at the Virtual
Reality Medical Center to test the usability and safety in patients with chronic pain.
Patients were presented with pleasant relaxing scenes including natural areas like forests,
beaches, and mountains, with relaxing and soothing effects to help mimic slowed breathing.
Researchers in this study found that the pain distraction virtual environment (VE) was easy
to use, had good stereo sound effects, and was immersive and interactive. They also found
that patients experienced low levels of fatigue, headache, eyestrain, and nausea when using
the VR device. No studies have involved VR in setting of anesthesia induction period and a
non-pharmacological intervention for preoperative anxiety.
A pilot study conducted by Wiederhold et al, tested 6 chronic pain patients using a
head-mounted VR device. All six study participants reported a significant drop in pain while
using the natural VE. Similarly, a study from the University of Washington found that
children playing VR video games or navigating through a virtual environment while receiving
wound care for their burns had lower pain scores than patients who just played video games.
Another study conducted by Wiederhold et al., looked at fear and pain before and after dental
treatment and found a significant decrease in pain perception and stated anxiety scores in
patients using the VR eyeglasses compared to the nonuse group.
Based on success in other medical procedures, we propose a study to examine the efficacy and
feasibility of using VR during induction of anesthesia to help minimize anxiety,
postoperative pain and analgesic use in patients undergoing a tonsillectomy or a
tonsillectomy and adenoidectomy procedure.
year, and approximately 50% of pediatric patients experience significant stress and anxiety
before their surgery. High anxiety can result in increased postoperative pain, increased
analgesic consumption, and delayed recovery. The perception of pain can have a strong
psychological component and can increase if the patient gives the area of injury constant
attention. Thus, different distraction techniques have been utilized by pain psychologists to
take the patient's attention away from the area of injury.
Pharmacological intervention to treat preoperative anxiety in children has its own
side-effect profile. Midazolam is a common medication used parentally, nasally, or orally to
alleviate preoperative anxiety. However, there are many side-effects that are not always
preventable. Reports of 3.8% of patients having paradoxical effects from midazolam have been
documented, and delayed emergence is possible in surgeries of short duration. In addition,
midazolam can also result in critical events perioperatively, such as airway obstruction and
worsened nausea and vomiting. Non-pharmacological interventions could help avoid these
complications, however, current studies do not show a viable alternative to a pharmacological
interventions.
Virtual Reality (VR) is a technology that allows individuals to experience a virtual world.
VR initially began as a form of entertainment, but it has expanded its application into
several other areas. Within the past 10 years, this type of technology has been applied
clinically as a method of distraction for medical procedures such as chemotherapy, physical
therapy, burn wound changes, and surgery. VR allows the patients to be immersed in an
interactive world stimulating sights, sounds, and motion to help enhance the distraction from
pain, ultimately reducing anxiety. A small validation study was conducted at the Virtual
Reality Medical Center to test the usability and safety in patients with chronic pain.
Patients were presented with pleasant relaxing scenes including natural areas like forests,
beaches, and mountains, with relaxing and soothing effects to help mimic slowed breathing.
Researchers in this study found that the pain distraction virtual environment (VE) was easy
to use, had good stereo sound effects, and was immersive and interactive. They also found
that patients experienced low levels of fatigue, headache, eyestrain, and nausea when using
the VR device. No studies have involved VR in setting of anesthesia induction period and a
non-pharmacological intervention for preoperative anxiety.
A pilot study conducted by Wiederhold et al, tested 6 chronic pain patients using a
head-mounted VR device. All six study participants reported a significant drop in pain while
using the natural VE. Similarly, a study from the University of Washington found that
children playing VR video games or navigating through a virtual environment while receiving
wound care for their burns had lower pain scores than patients who just played video games.
Another study conducted by Wiederhold et al., looked at fear and pain before and after dental
treatment and found a significant decrease in pain perception and stated anxiety scores in
patients using the VR eyeglasses compared to the nonuse group.
Based on success in other medical procedures, we propose a study to examine the efficacy and
feasibility of using VR during induction of anesthesia to help minimize anxiety,
postoperative pain and analgesic use in patients undergoing a tonsillectomy or a
tonsillectomy and adenoidectomy procedure.
Inclusion Criteria:
- Any patient undergoing tonsillectomy or tonsillectomy and adenoidectomy procedure
- Must be between the ages of 5 and 11 years
- Anxious/moderate anxiety patients (mYPAS greater than or equal to 30)
Exclusion Criteria:
- Any patient with preoperative peripherally placed IV
- Any patient who is cognitively impaired
- Any patient with a previous surgery
- ASA Physical Status higher than II
- Body Mass Index >30
- A history of affective disorder, attention disorder, or psychotropic medication use
- Calm/low anxiety patients (mYPAS less than 30)
- Deaf or blind
We found this trial at
1
site
1919 E Thomas Rd
Phoenix, Arizona 85006
Phoenix, Arizona 85006
(602) 933-1000
Phone: 602-933-4482
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