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Research project

Virtual reality before day care surgery in children (VR)

Status: Ongoing

We have developed a virtual reality exposure tool and are researching its effectiveness on anxiety and pain reduction in children undergoing elective day care surgery.

What we do

About our project

Background information 

Fifty to 70% of children show high anxiety and distress before surgery. Anxious children are more often agitated, sad, and less cooperative than children who are not anxious. Anxiety before surgery is also related to an increased risk of emergence delirium, more intense pain, and poorer recovery after surgery. Furthermore, a child’s operation is a stressful experience for parents. In turn, anxiety of a parent can intensify the child’s anxiety. Therefore, it is important to develop an effective strategy to minimize anxiety before surgery.

Overall aim 

The aims of the PREoperative Virtual reality Intervention to Enhance Wellbeing (PREVIEW) study are (1) to develop a virtual reality exposure tool that replicates the operating theater of the Erasmus MC Sophia Children’s Hospital, Rotterdam, the Netherlands; and (2) to test the effectiveness of this tool to minimize preoperative anxiety of children undergoing elective day care surgery.
Virtual reality exposure offers children a highly realistic virtual environment that mimics the operating theater of a hospital. Children can get accustomed not only to the operating environment, but also to the anesthesia procedures.

Research method 

We are conducting a single-blinded, randomized controlled trial comparing virtual reality exposure to care as usual, in 4- to 12-year-old children undergoing elective day care surgery for maxillofacial, dental, or ear-nose-throat problems (N=200). The virtual reality exposure intervention is offered in a separate room, in the presence of a parent.The main outcome is anxiety, of both the child and parent, before and after surgery. Also, emergence delirium, pain, use of analgesics, and health care use will be examined after surgery.

The virtual reality holding area

Figure 1: The virtual reality holding area.

Being brought to the operating theater in virtual reality

Figure 2: Being brought to the operating theater in virtual reality.

The virtual reality operating room

Figure 3: The virtual reality operating room.

Desirable outcome

By preparing children for anesthesia and surgery with an innovative virtual reality exposure tool, instead of distracting them, we hope to improve clinical and psychological outcomes.


Development of a Virtual Reality Exposure Tool as Psychological Preparation for Elective Pediatric Day Care Surgery: Methodological Approach for a Randomized Controlled Trial.Robin Eijlers, Jeroen S Legerstee, Bram Dierckx, Lonneke M Staals, Johan Berghmans, Marc P van der Schroeff, Rene Mh Wijnen, Elisabeth Mwj Utens. JMIR Res Protoc. 2017 Sep 11;6(9):e174. doi: 10.2196/resprot.7617.

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