BACKGROUND Preoperative anxiety is common in children. It can contribute to negative experiences with anesthetic induction and may cause adverse physiological and psychological effects. Virtual reality (VR) and electronic tablet devices are 2 audiovisual distraction tools that may help to reduce anxiety and enhance the preoperative experience. This study aimed to compare the use of an immersive 3-dimensional (3D) VR to 2-dimensional (2D) video on anxiety in children during induction of general anesthesia. METHODS Two hundred children (4-13 years) undergoing elective or emergency surgery under general anesthesia were enrolled in this randomized, controlled trial. Participants were randomized to use either the 3D VR goggles (intervention) or 2D video tablet (control) during anesthetic induction. Anxiety, the primary outcome, was measured using the modified Yale Preoperative Anxiety Scale Short Form (mYPAS-SF) at 2 time points: in the preoperative holding area before randomization (T1) and during induction of general anesthesia (T2). The primary outcome was analyzed using a linear regression model, including demographic and other covariates, to investigate any differences in anxiety scores. Secondary outcomes included evaluating compliance during the anesthetic induction (Induction Compliance Checklist), emergence of delirium (Cornell Assessment of Pediatric Delirium), perceived usefulness of the device, and child satisfaction. RESULTS Participant characteristics were similar between the 3D VR (n = 98) and 2D video (n = 90) groups, with a mean (±standard deviation) age 8. 8 ± 2.8 years. The median (lower quartile, upper quartile) mYPAS-SF scores for the 3D VR group at the preoperative holding area were 22.9 (22.9, 35.4), then 29.2 (24.0, 41.7) during induction. For the 2D Video group, the scores were 27.1 (22.9, 35.4) and then 30.2 (22.9, 41.1). No significant difference was observed in the increase in mYPAS-SF scores between groups (P = .672). Children in the 3D VR group were less likely to be rated as having a perfect induction (P = .039). There was no evidence of a difference between the groups in emergence delirium. Both devices were rated highly for usefulness and patient satisfaction. Children preferred VR, while anesthesiologists and parents felt the 2D was more useful. CONCLUSIONS This randomized controlled trial demonstrated that preoperative anxiety was equally low and induction compliance high with both 3D VR and 2D video distraction in children with parental presence during anesthetic induction.

中文翻译：

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3 维虚拟现实与 2 维视频在儿童麻醉诱导过程中分散注意力以减少焦虑：一项随机对照试验。


背景技术术前焦虑在儿童中很常见。它可能会导致麻醉诱导的负面体验，并可能导致不良的生理和心理影响。虚拟现实 (VR) 和电子平板设备是两种视听分散注意力的工具，可能有助于减少焦虑并增强术前体验。本研究旨在比较沉浸式 3 维 (3D) VR 与 2 维 (2D) 视频对儿童全身麻醉诱导期间焦虑的影响。方法 200 名在全身麻醉下接受选择性或紧急手术的儿童（4-13 岁）被纳入这项随机对照试验。参与者在麻醉诱导期间被随机分配使用 3D VR 护目镜（干预）或 2D 视频平板电脑（对照）。焦虑是主要结果，使用改良的耶鲁术前焦虑量表简表（mYPAS-SF）在两个时间点进行测量：随机分组前的术前等待区（T1）和全身麻醉诱导期间（T2）。使用线性回归模型分析主要结果，包括人口统计和其他协变量，以调查焦虑评分的差异。次要结果包括评估麻醉诱导期间的依从性（诱导依从性检查表）、谵妄的出现（康奈尔儿科谵妄评估）、设备的感知有用性和儿童满意度。结果 3D VR (n = 98) 和 2D 视频 (n = 90) 组的参与者特征相似，平均年龄（±标准差）为 8. 8 ± 2.8 岁。 3D VR 组术前握持区域的中位（下四分位、上四分位）mYPAS-SF 评分为 22.9（22.9，35.4），诱导期间为 29.2（24.0，41.7）。 对于 2D 视频组，得分为 27.1 (22.9, 35.4)，然后是 30.2 (22.9, 41.1)。组间 mYPAS-SF 评分的增加没有观察到显着差异 (P = .672)。 3D VR 组的儿童不太可能被评为完美诱导 (P = .039)。没有证据表明各组之间的苏醒性谵妄存在差异。这两种设备的实用性和患者满意度都得到了高度评​​价。孩子们更喜欢 VR，而麻醉师和家长则认为 2D 更有用。结论 这项随机对照试验表明，在麻醉诱导期间有父母在场的情况下，3D VR 和 2D 视频分散儿童的术前焦虑程度同样较低，且诱导依从性较高。