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

• Received:
• December 11, 2025
• Accepted:
• January 07, 2026
• Published:
• January 23, 2026

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