Before going into surgery, most patients want—and often need—sedation to relieve pain and ease anxiety. But sedatives are sometimes over-prescribed, which can lead to difficulty breathing and low blood pressure. In a recent study, researchers at Beth Israel Deaconess Medical Center found that virtual reality offers a possible alternative to sedation.
“We are always looking for possible non-pharmacological treatments that do not require sedating drugs,” says Adele Farukian anesthetist who led the study at Beth Israel Deaconess.
Patients undergoing hand surgery usually receive injections that numb the arm. After that, “the only anesthetic patients really need is enough relaxant or sedative medication to make sure they don’t suffer from anxiety,” says Faruki, who now works at the University of Colorado.
In the small trial, 17 patients wore a virtual reality headset during their hand surgery, while another 17 patients did not experience virtual reality. Patients had the option of listening to a guided meditation, watching a video, or immersing themselves in a peaceful meadow or forest through a VR headset. After the operation, the researchers found that 13 of the 17 VR patients received no sedation during the operation, while all patients who did not undergo VR received sedation. VR patients received, on average, about 83% less propofol (a type of sedative) than those without VR. After surgery, VR patients reported being significantly more conscious during surgery than those who were sedated, but their pain and anxiety levels remained the same.
It’s important to look at both the dosage and the patient’s experience, says Brian O’Gara, an anesthesiologist at Beth Israel Deaconess who supervised the study. The fact that receiving lower doses didn’t come at the cost of a bad patient experience is what makes the results compelling, he says.
Without the lingering effects of sedation, VR patients were discharged from the post-operative care unit after 53 minutes, an average of 22 minutes earlier than those in the control group. The time it takes to recover from surgery affects the number of surgeries doctors can perform in a day, Faruki says, which means hospitals could treat more patients.
This is only the third study to test reductions in sedative doses during virtual reality immersion, and the first to find significant results, according to O’Gara. He suggests this could be because patients had the ability to choose the type of VR experience they wanted. In previous studies, patients didn’t have the ability to choose what they saw, which may have led to boredom and reduced the ability of virtual reality to distract the patient, he says.
“I’m not surprised at all that VR worked,” says F. Kayser Enneking, a University of Florida anesthesiologist who was not involved in the research. Using distractions during surgery like listening to music, watching TV, or even talking to the doctor has long been known to reduce pain and the dose of sedatives patients receive. Virtual reality may be a better form of distraction “because it’s immersive and patients can’t hear or see anything else,” O’Gara suggests.
An important caveat to this study, however, is that anesthesiologists determined the propofol dosage for patients who underwent the VR experience, without any input from the patient. If the anesthesiologist is looking at someone with a virtual reality headset, they may give them less propofol, O’Gara says. It is therefore difficult to determine whether some patients really needed more or less sedation during surgery than others.
O’Gara’s team addresses this limitation in a larger follow-up study at Beth Israel Deaconess. This time, patients not experiencing VR will still be wearing a headset, not watching any content, so anesthesiologists won’t know who might need less sedation. The follow-up study, which will be completed by the end of 2023, includes older patients undergoing knee surgery. Older people are more prone to the side effects of sedatives, especially confusion and cognitive dysfunction.
“Now that we’ve proven that we can do it, period, for patients, we’re looking to see if we can do it for patients who are at a bit more risk,” O’Gara says.