Virtual Reality Exposure to Prepare Children for Surgery: Effects on Anxiety and Pain

We have developed a psychological intervention to prepare children for surgery under general anesthesia. This intervention consists of Virtual Reality Exposure. The effectiveness of this intervention to reduce anxiety and pain has been investigated in a randomized controlled trial

Snake pictures draw more early attention than spider pictures in non-phobic women: Evidence from event-related brain potentials

Snakes were probably the first predators of mammals and may have been important agents of evolutionary changes in the primate visual system allowing rapid visual detection of fearful stimuli (Isbell, 2006). By means of early and late attention-related brain potentials, we examined the hypothesis that more early visual attention is automatically allocated to snakes than to spiders. To measure the early posterior negativity (EPN), 24 healthy, non-phobic women watched the random rapid serial presentation of 600 snake pictures, 600 spider pictures, and 600 bird pictures (three pictures per second). To measure the late positive potential (LPP), they also watched similar pictures (30 pictures per stimulus category) in a non-speeded presentation. The EPN amplitude was largest for snake pictures, intermediate for spider pictures and smallest for bird pictures. The LPP was significantly larger for both snake and spider pictures when compared to bird pictures. Interestingly, spider fear (as measured by a questionnaire) was associated with EPN amplitude for spider pictures, whereas snake fear was not associated with EPN amplitude for snake pictures. The results suggest that ancestral priorities modulate the early capture of visual attention and that early attention to snakes is more innate and independent of reported fear

Predicting Intense Levels of Child Anxiety During Anesthesia Induction at Hospital Arrival

In children, intense levels of anxiety during anesthetic induction are associated with a higher risk of pain, poor recovery, and emergence delirium. Therefore, it is important to identify these high-risk children at hospital arrival. The current study examined internalizing behavior (Child Behavior Checklist, CBCL) and state anxiety measures (modified Yale Preoperative Anxiety Scale, mYPAS, and State Trait Anxiety Inventory for Children, STAIC) at hospital arrival as predictors of anxiety during induction of anesthesia. One hundred children (aged 4 to 12 years) undergoing elective daycare surgery were included. The STAIC and mYPAS at hospital arrival were significant predictors of anxiety during induction, whereas CBCL was not. The STAIC state form at hospital arrival was the strongest predictor and could be used to identify children who will experience intense levels of anxiety during anesthetic induction, with sufficient to good diagnostic accuracy. Using the STAIC at hospital arrival allows targeted interventions to reduce anxiety in children

Systematic Review and Meta-analysis of Virtual Reality in Pediatrics

BACKGROUND: Medical procedures often evoke pain and anxiety in pediatric patients. Virtual reality (VR) is a relatively new intervention that can be used to provide distraction during, or to prepare patients for, medical procedures. This meta-analysis is the first to collate evidence on the effectiveness of VR on reducing pain and anxiety in pediatric patients undergoing medical procedures. METHODS: On April 25, 2018, we searched EMBASE, MEDLINE, CENTRAL, PubMed, Web of Science, and PsycINFO with the keywords “VR,” “children,” and “adolescents.” Studies that applied VR in a somatic setting with participants ≤21 years of age were included. VR was defined as a fully immersive 3-dimensional environment displayed in surround stereoscopic vision on a head-mounted display (HMD). We evaluated pain and anxiety outcomes during medical procedures in VR and standard care conditions. RESULTS: We identified 2889 citations, of which 17 met our inclusion criteria. VR was applied as distraction (n = 16) during venous access, dental, burn, or oncological care or as exposure (n = 1) before elective surgery under general anesthesia. The effect of VR was mostly studied in patients receiving burn care (n = 6). The overall weighted standardized mean difference (SMD) for VR was 1.30 (95% CI, 0.68–1.91) on patient-reported pain (based on 14 studies) and 1.32 (95% CI, 0.21–2.44) on patient-reported anxiety (based on 7 studies). T

Snake pictures draw more early attention than spider pictures in non-phobic women : Evidence from event-related brain potentials

Snakes were probably the first predators of mammals and may have been important agents of evolutionary changes in the primate visual system allowing rapid visual detection of fearful stimuli (Isbell, 2006). By means of early and late attention-related brain potentials, we examined the hypothesis that more early visual attention is automatically allocated to snakes than to spiders. To measure the early posterior negativity (EPN), 24 healthy, non-phobic women watched the random rapid serial presentation of 600 snake pictures, 600 spider pictures, and 600 bird pictures (three pictures per second). To measure the late positive potential (LPP), they also watched similar pictures (30 pictures per stimulus category) in a non-speeded presentation. The EPN amplitude was largest for snake pictures, intermediate for spider pictures and smallest for bird pictures. The LPP was significantly larger for both snake and spider pictures when compared to bird pictures. Interestingly, spider fear (as measured by a questionnaire) was associated with EPN amplitude for spider pictures, whereas snake fear was not associated with EPN amplitude for snake pictures. The results suggest that ancestral priorities modulate the early capture of visual attention and that early attention to snakes is more innate and independent of reported fear

Development of a virtual reality exposure tool as psychological preparation for elective pediatric day care surgery: Methodological approach for a randomized controlled trial

Background Preoperative anxiety in children is highly prevalent and is associated with adverse outcomes. Existing psychosocial interventions to reduce preoperative anxiety are often aimed at distraction and are of limited efficacy. Gradual exposure is a far more effective way to reduce anxiety. Virtual reality (VR) provides a unique opportunity to gradually expose children to all aspects of the operating theater. Objective The aims of our study are (1) to develop a virtual reality exposure (VRE) tool to prepare children psychologically for surgery; and (2) to examine the efficacy of the VRE tool in a randomized controlled trial (RCT), in which VRE will be compared to care as usual (CAU). Methods The VRE tool is highly realistic and resembles the operating room environment accurately. With this tool, children will not only be able to explore the operating room environment, but also get accustomed to general anesthesia procedures. The PREoperative Virtual reality Intervention to Enhance Wellbeing (PREVIEW) study will be conducted. In this single-blinded RCT, 200 consecutive patients (aged 4 to 12 years) undergoing elective day care surgery for dental, oral, or ear-nose-throat problems, will be randomly allocated to the preoperative VRE intervention or CAU. The primary outcome is change in child state anxiety level between baseline and induction of anesthesia. Secondary outcome measures include child’s postoperative anxiety, emergence delirium, postoperative pain, use of analgesics, health care use, and pre- and postoperative parental anxiety. Results The VRE tool has been developed. Participant recruitment began March 2017 and is expected to be completed by September 2018. Conclusions To our knowledge, this is the first RCT evaluating the effect of a VRE tool to prepare children for surgery. The VRE intervention is expected to significantly diminish preoperative anxiety, postoperative pain, and the use of postoperative analgesics in pediatric patients. The tool could create a less stressful experience for both children and their parents, in line with the modern emphasis on patient- and family-centered care. Trial Registration Netherlands Trial Registry: NTR6116; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6116 (Archived by WebCite at http://www.webcitation.org/6ryke7aep) Identifier: E-ISSN: 1929-0748 ; DOI: 10.2196/resprot.7617 ; PMCID: 5613189 ; PMID: 2889372