VCU study shows virtual reality can benefit kids before surgery and potentially beyond

By Kate Marino
Children's Hospital of Richmond at VCU

Surgery can make anyone anxious, especially kids. Narendra Vadlamudi, M.D., a gastroenterologist at Children's Hospital of Richmond at VCU and associate professor with Virginia Commonwealth University's School of Medicine, has been doing procedures that require children to be under anesthesia for more than a decade. These patients wait approximately an hour before being taken to the operating room, a period often involving IV placement and capturing vital signs.

"Think of an anxious child walking in and having to sit with these feelings for an hour or more," Vadlamudi said. "My thought process over the years has been, 'How can we help these kids?'"

While calming medicines can be beneficial, they can also cause side effects, including unexpected reactions and slowed breathing. Vadlamudi began imagining environmental options for easing anxiety, and all roads led to virtual reality.

"With virtual reality goggles, kids can play games but you're also blocking their visual field so they're not worried about what's happening around them in the pre-op area," he said.

Vadlamudi's original idea was to provide an educational experience related to the child's specific procedure. In an upper endoscopy, for example, a scope passes through the esophagus, stomach and duodenum. He envisioned a child riding a water park tube through all the bends, curves and tunnels - passing the tonsils, traveling into the airway and splashing into the stomach.

With his idea in hand, Vadlamudi sought someone with the technological expertise to help make it happen. As he met with prospective partners, he was introduced to Dayanjan Wijesinghe, Ph.D., associate professor in the Department of Pharmacotherapy and Outcomes Science at VCU School of Pharmacy. Wijesinghe was simultaneously working with a doctoral student to build a VR lab, and it turned out to be the perfect pairing.

"Virtual reality had shown promise in research settings, but there was very little evidence on whether it could work as part of everyday care in a busy surgical unit run by the regular staff," Wijesinghe said. "Rather than running a one-off experiment, we built a custom, child-friendly VR experience and spent nine months making it part of routine care in the preoperative holding area at CHoR."

While it wasn't exactly Vadlamudi's water ride brainstorm, it was a similar step forward in investigating the impact of VR on preoperative anxiety in children. The researchers' findings were recently published in PLOS Digital Health.

VR was feasible, safe and well-liked by patients, parents and nurses in VCU study

Eighty children, ages 6 to 15 years old, took part in the resulting study.

The participants wore VR goggles to explore one of two calm worlds while awaiting surgery:

• A children's room with familiar toys that responded when the child looked at them or used the controller, a virtual television showing age-appropriate content, soft blues and greens, and calm background music at a resting-heart-rate tempo of 60-70 beats per minute
• A beach scene with gentle waves, palm trees, drifting clouds and ocean sounds

The child directed each session, lasting nine minutes on average, which researchers say was enough time for them to fully engage in the activity and for nurses to assess vitals and place IV lines. Parents could watch what their child was seeing on a tablet, so they shared the experience and some of the calming benefits.

"The goal was to keep the child as comfortable as possible. The care and overall patient and family experience are both better when children are more comfortable," Vadlamudi said.

Feedback was positive with 91% of the pediatric study participants saying they would like to use VR again, and 89% saying it helped with their anxiety. Happier, calmer children led to satisfied parents too; 95% of parents involved in the study said they would recommend VR for other children.

"Parents were often surprised at how easily their child tolerated getting an IV when using the VR headset and you could just feel the anxiety leave the room," said Siri Garrett, certified child life specialist in the perioperative setting and a key partner in the study process.

On the clinical side, 83% of nurses rated the system extremely easy to manage.

"It was fun to see how the patients responded to being offered the use of VR. For some of our patients, they were familiar with VR from personal experiences and were excited to be able to immerse themselves while at the hospital. For others, this was their first time using VR and their reactions were precious in how amazed they were at what they were seeing," Garrett said. "Regardless, it helped immensely when they were getting their IV. The novelty and distraction of the VR often took their mind completely off what they were feeling."

A springboard for further studies on ways VR can help kids in the hospital

This study measured anxiety, heart rate and blood pressure before and after VR. After the session, children reported less distress and less fear. Their average heart rate per minute and blood pressure were also lower compared to their screenings before the VR session began. Though there were no noticeable differences based on age, there was an observable pattern that the children who were most anxious before VR showed the biggest drops afterward.

Further controlled trials can confirm how much of this improvement comes specifically from VR versus acclimating to the environment. Researchers say future work can also look into other potential benefits, such as whether VR before surgery leads to smoother anesthesia and recovery. This is notable, as studies link high anxiety before surgery to a harder start to anesthesia, a higher risk of agitation on waking, more pain after surgery, longer recovery and negative feelings about healthcare that can carry into later visits. There is now a reliable foundation for those follow-up studies.

"Our experience shows that VR can be built into everyday surgical care safely and smoothly, and that it offers a promising, drug-free way to support children facing surgery," Wijesinghe said. "It's important to note that it complements, rather than replaces, other care. We see VR as an option alongside existing approaches, not a substitute for medication when a child needs it."

Vadlamudi also envisions broader benefits for similar VR implementations - perhaps even with his water park fun added to the mix.

"The next thing I'd like to do is go into the infusion center and then our hematology/oncology unit where they need to access ports and draw blood," he said. "Then it can be used in the regular clinic for children who are very anxious to walk into that space. If the equipment is available, this study proved that it can work really well."

This story was originally published on the Children's Hospital of Richmond at VCU website.