Use of virtual reality in reducing pediatric perioperative anxiety: A literature synthesis review for current evidence based practice

Abstract

Background and objective: Pediatric patients frequently experience significant preoperative anxiety, with prevalence estimates ranging from 50% to 75%. This anxiety is associated with adverse outcomes, including increased postoperative pain, emergence agitation or delirium, prolonged recovery, and elevated healthcare costs. Despite heightened interest in non-pharmacologic interventions, awareness among healthcare providers regarding the substantial evidence supporting immersive technologies such as Virtual Reality (VR) to mitigate preoperative anxiety in children may remain limited. The objective of this systematic literature synthesis was to critically evaluate and consolidate contemporary evidence regarding the use of Virtual Reality as an intervention to reduce anxiety in pediatric perioperative care. The review also aimed to examine comparative effectiveness, implementation feasibility, and implications for translating evidence into clinical practice.

Methods A systematic search of PubMed, CINAHL, Embase, and the Cochrane Library was conducted to identify empirical studies published between January 2017 and March 2025 that examined VR interventions for pediatric preoperative anxiety. The search included randomized controlled trials, systematic reviews, meta-analyses, and quasi-experimental studies. Eligibility criteria included studies involving pediatric patients (ages 3-18) undergoing surgical procedures with VR used as a preoperative or perioperative anxiety-reducing tool. Quality appraisal was performed using the Johns Hopkins Nursing Evidence-Based Practice tool. After utilizing strict inclusion and exclusion criteria, 30 studies were included in this systematic evaluation.

Results Findings consistently demonstrated that VR reduced preoperative anxiety compared to standard care or alternative distraction methods. Studies reported improvements in physiological indicators, patient satisfaction, procedural cooperation, and reduced sedative requirements. Barriers to adoption include provider unfamiliarity, cost, and logistical constraints. Several implementation-enabling strategies were also identified, including education, institutional support, and integration into care protocols.

Conclusions VR is an effective, non-pharmacologic intervention for reducing preoperative anxiety in pediatric patients. The evidence from this systematic literature synthesis supports integration of VR into perioperative workflows. This synthesis offers a foundation for practice change, underscoring the need for continued provider education and institutional readiness to adopt VR-based strategies.

Keywords

Knowledge translation / Literature synthesis / Non-pharmacologic intervention / Pediatric anesthesia / Perioperative care / Preoperative anxiety / Virtual reality

AUTHORS CONTRIBUTIONS

Dr. Kristie Hoch, DNP, CRNA, MS, FAANA; Dr. Christopher Herring, DNP, CRNA; and Dr. Luc Corriveau, DNP, MBA, CRNA contributed to the conception and design of the study, literature synthesis, and interpretation of findings. All authors participated in drafting and critically revising the manuscript for important intellectual content. All authors read and approved the final manuscript and agree to be accountable for all aspects of the work.

FUNDING

Not Applicable.

CONFLICTS OF INTEREST DISCLOSURE

The authors declare that there is no conflict of interest.

INFORMED CONSENT

Obtained.

ETHICS APPROVAL

The Publication Ethics Committee of the Association for Health Sciences and Education. The journal’s policies adhere to the Core Practices established by the Committee on Publication Ethics (COPE).

PROVENANCE AND PEER REVIEW

Not commissioned; externally double-blind peer reviewed.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

DATA SHARING STATEMENT

No additional data are available.

ACKNOWLEDGEMENTS

I would like to sincerely thank my DNP advisory committee for their guidance, support, and constant vigilance throughout the development of this manuscript. Their expertise, thoughtful feedback, and commitment to scholarly excellence were invaluable in strengthening this work.

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