Study: Patients immersed in virtual reality during surgery require less anesthesia

A recent study published in PLOS A and conducted by researchers at Beth Israel Deaconess Medical Center in Boston reveals that the use of virtual reality during hand surgery led to significant reductions in intraoperative anesthesia without negatively impacting patient-reported outcomes.

In a small eight-month randomized controlled trial, researchers evaluated 34 patients undergoing hand surgery and the amount of anesthesia administered intraoperatively in conjunction with or without the use of virtual reality.

The VR group received significantly less propofol per hour than the control group. Notably, post-anaesthetic care unit (PACU) length of stay was markedly reduced in the VR group, with patients discharged from the PACU 22 minutes earlier than control patients.

Patients were divided into a control group, under anesthesia as recommended by an anesthetist during surgery, and a VR group, who viewed programming of their choice through a virtual reality headset and noise canceling headphones.

Virtual programming, provided by the VR telehealth clinic company XRHealth, was designed to promote relaxation and calm, like a peaceful meadow, forest or mountain peak. Patients could also listen to a guided meditation in the immersive environments or choose from a library of videos on a web user interface displayed as a movie screen surrounded by a “starry sky” background.

WHY IS IT IMPORTANT

A common practice for anesthesia during hand surgery combines regional anesthesia given before surgery and monitored anesthetic care during surgery.

Although patients receive anesthesia preoperatively, they may require additional anesthesia intraoperatively, which can lead to oversedation and potentially preventable complications.

The researchers of the study above noted that “virtual reality could prove to be a valuable tool for patients and providers by distracting the mind from processing noxious stimuli, which would reduce the use of sedatives and the risk of oversedation without negative impact on patient satisfaction”.

However, they reported limitations within the study, including participants being aware of the possibility of reduced sedative dosage. There could also be a selection bias, as the results of patients who accepted minimal sedation may not be generalizable to the whole population.

Additionally, the providers in the study were not blinded, which may have contributed to the dramatic differences in propofol dosage between the groups, the researchers wrote.

“Due to the potential for bias to influence both of these results, our results should be interpreted as preliminary and in need of validation in future trials. Further, given these major limitations, our results are therefore best suited to describe how the incorporation of VR immersion into the current practice of anesthesia for hand surgery can compare to the standard of care, not to prove that virtual reality is an effective pain control modality or is superior to other distraction techniques,” the researchers noted.

THE GREAT TREND

Extended reality (i.e. virtual, augmented and mixed reality) is currently used in various forms in the operating room and affects patients and surgeons.

Surgeons use augmented reality technology via Augmedics xvision system for spine surgery. Augmedics’ technology allows a surgeon to view a 3D model of a patient’s spine during implant surgery and has demonstrated 99.1% percutaneous screw placement accuracy.

Precision XR Surgical theater allows surgeons to visualize a surgical experience by capturing 3D imaging models in virtual reality. Providers perform a classic scan of the patient’s body (MRI, CT scan, etc.). This scan is reconstructed into a virtual reality 3D image that surgeons analyze in depth to prepare for an operation.

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