Authors: Shao Y et al.
Pediatric Anesthesia, first published March 9, 2026, 10.1002/pan.70165
This randomized controlled trial evaluated whether immersive gaming intervention (IGI) could reduce preoperative anxiety and improve cooperation in children undergoing extraction of supernumerary teeth under general anesthesia. Pediatric preoperative anxiety is common and can worsen physiologic stress responses, increase anesthetic requirements, and complicate perioperative management. Nonpharmacologic strategies such as therapeutic play and digital interventions are increasingly being explored as alternatives or adjuncts to sedative medications.
The investigators conducted a prospective randomized controlled trial involving 102 children aged 4 to 12 years scheduled for supernumerary tooth extraction. Participants were randomized to either immersive gaming intervention (50 patients) or standard preoperative care (52 patients). The IGI intervention consisted of a multicomponent program including structured therapeutic play, role-reversal simulation in which children practiced the procedure through gameplay, and environmental modifications designed to reduce procedural stress.
Anxiety and physiologic stress responses were evaluated at three time points: baseline, after the intervention, and immediately preoperatively. Psychological anxiety was measured using the Screen for Child Anxiety Related Emotional Disorders (SCARED) scale. Physiologic responses were assessed using heart rate and heart rate variability, specifically the low-frequency/high-frequency (LF/HF) ratio as a marker of autonomic nervous system activity. Secondary outcomes included treatment compliance measured with the Frankl scale and parental satisfaction using a 100-point questionnaire.
Children who received the immersive gaming intervention demonstrated markedly lower anxiety levels compared with the standard care group. At the preoperative assessment, SCARED scores were dramatically lower in the intervention group, with a mean difference of 18.5 points. The effect size was very large, indicating a strong psychological benefit.
Physiologic stress markers also improved significantly. The intervention group had lower heart rates prior to surgery, with an average reduction of approximately 17 beats per minute compared with controls. Autonomic balance improved as well, as shown by a lower LF/HF ratio, suggesting reduced sympathetic dominance and better physiologic regulation of stress.
Another notable finding was that IGI appeared to weaken the link between psychological anxiety and physiologic stress responses. The slope relating anxiety scores to LF/HF ratio was reduced by about 65%, indicating that the intervention not only reduced anxiety but also diminished the physiologic amplification of emotional stress.
Behavioral cooperation during treatment improved substantially. Children in the immersive gaming group demonstrated far higher rates of active cooperation on the Frankl scale. Parental satisfaction was also significantly higher, with a large majority of parents rating their experience as “very satisfied.”
The authors conclude that immersive gaming interventions may provide a powerful nonpharmacologic strategy to improve the perioperative experience for pediatric patients. By combining play therapy, behavioral rehearsal, and immersive distraction, the intervention appears to reduce anxiety, improve physiologic stability, and increase procedural cooperation.
What You Should Know
Preoperative anxiety in children can increase sympathetic activation, complicate anesthetic induction, and worsen perioperative experiences.
Immersive gaming interventions combine therapeutic play, role-reversal simulation, and interactive distraction to prepare children for surgery.
This randomized trial showed large reductions in both psychological anxiety and physiologic stress markers before anesthesia.
The intervention also significantly improved cooperation during treatment and parental satisfaction.
Nonpharmacologic approaches such as immersive gaming may reduce the need for sedatives or anxiolytic medications in selected pediatric populations.
Key Points
Randomized controlled trial involving 102 children undergoing supernumerary tooth extraction.
Immersive gaming intervention significantly reduced anxiety scores compared with standard care.
Preoperative heart rate was reduced by about 17 beats per minute in the intervention group.
Autonomic stress markers (LF/HF ratio) improved, indicating reduced sympathetic activation.
Children receiving IGI showed markedly better cooperation and higher parental satisfaction.
Thank you to Pediatric Anesthesia for allowing us to summarize this article.