Effects of a virtual reality digital twin of the operating theatre on anxiety in pediatric surgery patients: a randomized controlled trial.

Background: Sevoflurane-based volatile induction and maintenance of anesthesia (VIMA) is common in pediatric outpatient surgery but can elevate preoperative anxiety in unfamiliar settings. This study compared the effects of immersive 3D virtual reality (VR) digital twin that precisely simulated the operating theatre environment with those of two-dimensional (2D) video education on preoperative anxiety in pediatric patients undergoing VIMA.

Methods: In total, 102 pediatric patients undergoing elective ambulatory surgery were randomly assigned to either the VR or tablet group. Identical preoperative education was provided through a 3D VR digital twin or tablet video. Preoperative anxiety, induction compliance, and procedural behavior during anesthesia induction were assessed using the modified Yale Preoperative Anxiety Scale (mYPAS), induction compliance checklist (ICC), and procedural behavior rating scale (PBRS), respectively. The VIMA induction times, and parental satisfaction were recorded.

Results: Children in the VR group exhibited lower mYPAS (33.3 [23.3-49.2] versus 46.7 [33.3-55.8], P = 0.022), higher ICC (P = 0.007), and lower PBRS (0.0 [0.0-1.0] versus 1.0 [0.0-2.0], P = 0.009) scores than those in the tablet group. The VIMA induction time was also shorter in the VR group (305.0 [253.5-392.5] versus 382.0 [329.0-480.0] s, P = 0.002), although parental satisfaction was comparable between the two groups.

Conclusions: Compared with video education, preoperative education utilizing an immersive 3D VR digital twin enhanced the efficacy of VIMA process, resulting in reduced preoperative anxiety, increased compliance, lower distress during anesthetic induction, and shorter induction time.