Pediatric anesthesia & critical care
Preoperative Virtual Reality for Pediatric Patients Undergoing General Anesthesia: A Meta‐Analysis of Randomized Controlled Trial
Authors' conclusion
Based on low to moderate quality evidence, preoperative virtual reality significantly improves compliance during anesthesia induction and offers possibly clinically significant improvements in preoperative anxiety, fear, procedural behavior, and parental satisfaction in pediatric patients undergoing general anesthesia. However, virtual reality shows a very low likelihood of clinical effect on postoperative pain, based on its very small effect size, and clearly no clinical effect on emergence delirium.
Study context
- Population
- Pediatric patients undergoing GA12 RCTs
- Comparison
- Preoperative virtual reality vs standard care
- Outcome
- Preoperative anxiety (mYPAS, change in mYPAS) and compliance during anesthesia induction (Induction Compliance Checklist)
Methodological detailsintention-to-treat RCTs, GRADE certainty assessment
- Intention-to-treat RCTs
- GRADE certainty assessment
Pooled result
As reported in the abstract
Preoperative anxiety and induction compliance
Virtual reality vs ControlWeighted MD (95% CI)P value
Modified Yale Preoperative Anxiety Scale scores; low evidence
−12.69(−16.17 to −9.20)
P < 0.001Change in Modified Yale Preoperative Anxiety Scale scores (greater change); low evidence
−9.54(−12.98 to −6.10)
P < 0.001Induction Compliance Checklist scores; low evidence
−1.67(−2.02 to −1.32)
P < 0.001Virtual reality vs ControlOdds ratio (95% CI)P value
Categorical Induction Compliance Checklist, perfect scores; moderate evidence
3.53(2.04–6.09)
P < 0.001Categorical Induction Compliance Checklist, moderate and poor scores; moderate evidence
0.28(0.16–0.49)
P < 0.001Further pooled results
| Outcome | Weighted mean difference (95% CI) | P value | |
|---|---|---|---|
| Preoperative fear (Children's Fear Scale)Moderate evidence | −2.30 (−2.54 to −2.07) | P < 0.001 | |
| Procedural behavior (Procedural Behavior Rating Scale)Moderate evidence | −1.00 (−1.12 to −0.88) | P < 0.001 | |
| Postoperative pain (Face, Legs, Activity, Cry, Consolability scale)Moderate evidence | −0.26 (−0.35 to −0.18) | P < 0.001 | |
| Postoperative pain (Wong-Baker FACES Pain Rating Scale)Moderate evidence | −0.44 (−0.61 to −0.28) | P < 0.001 | |
| Parental satisfactionModerate evidence | 0.68 (0.59–0.77) | P < 0.001 | |
| −4−202Difference (linear scale) |
Emergence delirium
- OR
- 1.05 (95% CI 0.59 to 1.89, p = 0.86)
- No statistically significant difference in emergence delirium
- Low evidence
Original publication
Preoperative Virtual Reality for Pediatric Patients Undergoing General Anesthesia: A Meta‐Analysis of Randomized Controlled Trial. Paediatr Anaesth. Published 23 July 2025. doi:10.
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