JMIR Publications

ABSTRACT

Background:

Pediatric patients undergoing surgery frequently experience significant anxiety, which can result in adverse effects such as prolonged sedation and behavioral changes associated with pharmacological interventions like oral midazolam. Video games offer a nonpharmacological distraction method that shows promise in alleviating procedural anxiety without significant side effects. However, the effectiveness of video games compared to midazolam in managing perioperative anxiety remains uncertain.

Objective:

This study aimed to evaluate the effectiveness of video game interventions in reducing perioperative anxiety in pediatric patients undergoing general anesthesia.

Methods:

We conducted a comprehensive search across PubMed, Embase, Web of Science (WOS), and the Cochrane Library, supplemented by reference screening, considering only articles published in English. Primary outcomes included anxiety levels assessed during parent separation and mask induction procedures, while secondary outcomes encompassed emergence delirium (ED), postoperative behavior, and length of stay in the Post-Anesthesia Care Unit (PACU). The risk of bias was assessed using the Risk of Bias 2.0 (ROB2.0) scale. Data were synthesized descriptively and through meta-analysis, with the certainty of the evidence evaluated using GRADE criteria.

Results:

Six randomized controlled trials involving 612 participants were included in the analysis. Children who participated in video game interventions reported significantly lower anxiety levels during parent separation (standardized mean difference [SMD] −0.31, 95% CI −0.50 to −0.12; P = 0.001), with high certainty, and during mask induction (SMD −0.29, 95% CI −0.52 to −0.05; P = 0.02), with moderate certainty, compared to those receiving oral midazolam. Additionally, significant differences in postoperative behavior changes in children were observed compared to oral midazolam (SMD −0.35, 95% CI −0.62 to −0.09; P = 0.008). However, no significant differences were found in ED (SMD −0.39, 95% CI −0.86 to 0.09; P = 0.11) and length of stay in the PACU (SMD −0.07, 95% CI −0.82 to 0.68; P = 0.11).

Conclusions:

Video game interventions were more effective than midazolam in reducing anxiety among pediatric patients during the perioperative period and in improving postoperative behavior. However, video games alone did not outperform midazolam in managing ED and PACU length of stay. Further high-quality research is needed for more conclusive results. Clinical Trial: PROSPERO CRD42023486085; https://www.crd.york.ac.uk/PROSPERO/;