Systematic review and meta-analysis on VR for pediatric anesthesia anxiety

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 standardized mean difference (SMD) 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 I 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 (SMD = -0.69, 95% CI [-0.96 to -0.42]). 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. While secondary outcomes such as parental anxiety and satisfaction showed positive trends, these findings should be interpreted with caution due to high heterogeneity.