Allowing children to experience virtually the process of receiving and recovering from an anesthetic is an effective and even enjoyable way for them to learn about the experience, according to investigators from The Hospital for Sick Children (SickKids), in Toronto.
Presenting the study at the 2017 meeting of the Society for Pediatric Anesthesia/American Academy of Pediatrics Section on Anesthesiology and Pain Medicine (abstract RRA-5), first author Ben O’Sullivan, MBChB, an anesthesia fellow at SickKids, said the use of virtual reality (VR) met with enthusiasm from children and their parents alike, and the positive results of this Phase II trial will be followed by an expanded prospective, Phase III, randomized controlled trial.
Following a Phase I trial in which Dr. O’Sullivan and his colleagues demonstrated that the use of VR to prepare children for the anesthetic experience was acceptable to health care providers, they recruited 93 children between 6 and 18 years old to participate in the study, along with their parents.
The children experienced an immersive video filmed with 360-degree cameras, and watched using smartphones inside Google Cardboard headsets, that mimicked the reality of receiving and recovering from an anesthetic. The VR experience was presented with the goal of improving children’s understanding of the anesthesia process, as well as helping to reduce preoperative anxiety and postoperative behavioral disorders.
VR Gets Kids’ Support
After the VR experience, the participants completed questionnaires to evaluate its ease of use (System Usability Scale [SUS]), level of realism, effect on their anxiety and their preference for VR over the standard slideshow approach.
The feedback from children was quite positive, according to the investigators, with 95.5% of them evaluating the VR experience as having prepared them well for anesthesia, and 90% stating they would want to use VR to prepare themselves for anesthesia in the future. Of the children, 98% rated the system as easy to use (95% CI, 92%-100%). Children and parents reported high usability scores of 85.6 and 86.5, respectively. (The SUS is not percentage based, and research indicates anything over 68 can be considered above average [www.usability.gov/?how-to-and-tools/?methods/?system-usability-scale.html]).
Participants who previously had undergone anesthesia reported that the VR experience was true to actual events, and overall, 93.3% (95% CI, 86%-98%) of the children reported that they would choose the VR experience over a slideshow to prepare themselves for anesthesia in the future.
In terms of negative reactions, two children experienced motion sickness or dizziness (2.15%; 95% CI, 0.5%-7%) and three found the video to be unpleasantly blurry (3.2%; 95% CI, 2%-10%), one of whom developed a headache as a result. The investigators noted that these symptoms did not prevent the children from completing the VR program.
“They felt that the symptoms were attributable to the fact that the video was filmed in a very standard definition,” Dr. O’Sullivan said. “We expect that if the video was filmed in high-[definition] 4K resolution, then this would improve the side effects even further.”
Parents in Favor Too
One parent commented that he or she felt isolated from the child’s experience, Dr. O’Sullivan said, after which the parents also were given the opportunity to view the video, either before or simultaneously with their children. He noted that this was the only negative parental comment received.
“In terms of positive feedback from children and parents, they loved all the new unique elements to the VR experience in preparing for [the] OR,” Dr. O’Sullivan said. “They thought it felt real. They thought they got more information as a result of using this experience.”
Based on this trial, Dr. O’Sullivan, together with his colleagues Clyde Matava, MBChB, MMEd, at SickKids, and Fahad Alam, MD, MEd, at Sunnybrook Health Sciences Centre of the University of Toronto, have created a VR mobile app that includes 360-degree videos of other parts of the hospital, such as the X-ray suite. They will test the value of the VR experience further in an upcoming prospective, randomized controlled trial.
Constance Houck, MD, FAAP, senior associate in perioperative anesthesia at Boston Children’s Hospital and associate professor in anesthesia at Harvard Medical School, in Boston, said she found the approach promising and looks forward to seeing it develop.
“There are definitely kids—especially little boys—that if you do something like this, it’s something that they’re easily distracted by,” Dr. Houck said. “And we could tell them stories, we could get them imagining that they’re astronauts and things like that.