Before undergoing surgery, most patients want—and often need—Sedation to reduce pain and manage anxiety. However, sedatives are sometimes over-prescribed, which can lead to breathing difficulties and low blood pressure. In a recent study, researchers at Beth Israel Deaconess Medical Center found this virtual reality offers a possible alternative for sedation.
“We’re always looking for possible non-pharmacological treatments that don’t require sedatives,” he says Adel Faroukian anesthetist who led the study at Beth Israel Deaconess.
Patients undergoing hand surgery are usually given injections that numb the arm. After that, “the only anesthetic patients really need is enough relaxing medication or sedatives to make sure they’re not scared,” says Faruki, who is now at the University of Colorado.
In the small study, 17 patients wore a virtual reality headset during their hand surgery, while another 17 patients did not experience virtual reality. Patients had the option to listen to a guided meditation, watch a video, or immerse themselves in a peaceful meadow or forest via a VR headset. After surgery, researchers found that 13 of the 17 patients in VR received no sedatives at all during surgery, while every patient who did not experience VR received sedatives. On average, VR patients received about 83% less propofol (a type of sedative) than non-VR patients. After surgery, the VR patients reported being much more conscious during the surgery than those who were sedated, but their pain and anxiety levels remained the same.
It’s important to look at both dosing and patient experience together, he says Brian O’Gara, an anesthetist at Beth Israel Deaconess who oversaw the study. The fact that lower doses weren’t administered at the expense of a poor patient experience makes the results compelling, he says.
Without the sustained effects of sedation, VR patients were discharged from the postoperative care unit at 53 minutes, which was an average of 22 minutes earlier than the control group. The time it takes to recover from surgery affects how many surgeries doctors can perform in a day, Faruki says, meaning hospitals could treat more patients.
According to O’Gara, this is only the third study to test reducing sedation doses during VR immersion, and the first to find significant results. He suggests this could be because patients had the option to choose what type of VR experience they wanted. In the previous studies, patients didn’t have the ability to choose what they watched, which may have led to boredom and reduced VR’s ability to distract the patient, he says.
“I’m not at all surprised that the VR worked,” he says F. Kayser Enneking, an anesthetist at the University of Florida who was not involved in the research. It has long been known that using distractions during surgery, such as listening to music, television, or even talking to the doctor, reduces pain and the dosage of sedatives patients receive. Virtual reality might be a better form of distraction “because it’s immersive and patients can’t hear or see anything else,” suggests O’Gara.
However, an important caveat about this study is that anesthesiologists set the propofol dosage for patients undergoing the VR experience without any patient say. If the anesthetist is looking at someone with a virtual reality headset, they might just give them less propofol, O’Gara says. This makes it difficult to determine whether some patients really needed more or less sedation than others during surgery.
O’Gara’s team is addressing this limitation in a larger follow-up study at Beth Israel Deaconess. This time, patients not experiencing virtual reality are still wearing a headset without viewing content, leaving anesthesiologists unaware who may need lower levels of sedation. The follow-up study, which will be completed by the end of 2023, includes elderly patients undergoing knee surgery. Older people are at greater risk of side effects from tranquilizers, particularly confusion and cognitive dysfunction.
“Now that we’ve proven we can do it for patients, let’s see if we can do it for patients who are a little more at risk,” O’Gara says.