Back to all available

Efficacy of virtual reality interventions in reducing preoperative anxiety in pediatric patients undergoing general anesthesia: A systematic review and meta-analysis

anesthesiology-and-pain-management
epidemiology
evidence-based-medicine
psychiatry-and-psychology
healthcare-services

Abstract

Objective: To evaluate the effectiveness of virtual reality (VR) interventions in reducing preoperative anxiety in pediatric patients undergoing general anesthesia, and provide evidence to inform clinical decision-making.

Methods: A comprehensive search was performed across PubMed, Embase, and the Cochrane Library, covering publications from inception to June 7, 2025. The study included randomized clinical trials (RCTs) of VR-based interventions (both immersive and non-immersive) compared to standard treatments or placebo controls. Studies assessing primary outcomes such as anxiety levels before induction, parent satisfaction, and postoperative delirium were included. Data synthesis was carried out using Review Manager software (version 5.4). The mean difference (MD) and 95% confidence intervals (CIs) were used to calculate the effect size for preoperative anxiety. Statistical heterogeneity was assessed with Cochran's Q test and I² statistics.

Results: A total of 12 studies were included in the meta-analysis, with participants undergoing various types of surgeries. The studies, published between 2017 and 2024, involved children from diverse regions, including South Korea, China, the United States, and others. The results indicated a significant reduction in preoperative anxiety for children who received VR interventions compared to controls (MD = -0.45, 95% CI: -0.78 to -0.12). Immersive VR showed a slightly higher effect in attracting children's attention and alleviating anxiety compared to non-immersive VR. Younger children (aged 3-6) exhibited a higher acceptance of VR and greater anxiety reduction, while older children (aged 7 and above) demonstrated less interest in VR interventions. Anxiety reduction was more pronounced for minor procedures but less effective for complex surgeries. Sensitivity analysis confirmed the robustness of these findings.

Conclusion: VR-based interventions, particularly immersive VR, are effective in reducing preoperative anxiety in pediatric patients undergoing general anesthesia. The efficacy is influenced by the child's age, the type of surgery, and the specific VR content used. These findings support the clinical application of VR as a tool for anxiety management in pediatric anesthesia settings.

Ask to review this manuscript

Notes for potential reviewers

  • Volunteering is not a guarantee that you will be asked to review. There are many reasons: reviewers must be qualified, there should be no conflicts of interest, a minimum of two reviewers have already accepted an invitation, etc.
  • This is NOT OPEN peer review. The review is single-blind, and all recommendations are sent privately to the Academic Editor handling the manuscript. All reviews are published and reviewers can choose to sign their reviews.
  • What happens after volunteering? It may be a few days before you receive an invitation to review with further instructions. You will need to accept the invitation to then become an official referee for the manuscript. If you do not receive an invitation it is for one of many possible reasons as noted above.
  • PeerJ does not judge submissions based on subjective measures such as novelty, impact or degree of advance. Effectively, reviewers are asked to comment on whether or not the submission is scientifically and technically sound and therefore deserves to join the scientific literature. Our Peer Review criteria can be found on the "Editorial Criteria" page - reviewers are specifically asked to comment on 3 broad areas: "Basic Reporting", "Experimental Design" and "Validity of the Findings".
  • Reviewers are expected to comment in a timely, professional, and constructive manner.
  • Until the article is published, reviewers must regard all information relating to the submission as strictly confidential.
  • When submitting a review, reviewers are given the option to "sign" their review (i.e. to associate their name with their comments). Otherwise, all review comments remain anonymous.
  • All reviews of published articles are published. This includes manuscript files, peer review comments, author rebuttals and revised materials.
  • Each time a decision is made by the Academic Editor, each reviewer will receive a copy of the Decision Letter (which will include the comments of all reviewers).

If you have any questions about submitting your review, please email us at [email protected].