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VR in the operating room: Virtual reality reduces the need for sedation during hand surgery

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Randomized Controlled Trial Shows VR Avoids Potential Harms of Oversedation Without Decreasing Patient Satisfaction

Boston – U.S. hand surgeons perform more than 500,000 procedures each year due to conditions such as carpal tunnel syndrome and osteoarthritis on the rise. Patients undergoing hand surgery typically receive local anesthesia to block pain before surgery and supervised anesthesia management (MAC) during surgery. MACs typically consist of an intravenous sedative, such as propofol, to keep patients from feeling drowsy during the procedure and to keep them awake enough to follow instructions if necessary. However, excessive sedation can lead to serious complications such as hypotension, upper airway obstruction, stroke, heart attack, and respiratory failure.

In a new attempt to reduce the risk of oversedation, physician-scientists at the Beth Israel Deaconess Medical Center (BIDMC) conducted a randomized controlled trial to test the use of sedatives during hand surgery without adversely affecting patient satisfaction. I’ve determined if I can minimize the need for . The team investigated adults undergoing hand surgery who were randomly assigned to receive either regular MAC plus virtual reality (VR) immersion during the procedure, or regular MAC only. . They found that immersion in VR during hand surgery significantly reduced sedation doses and length of stay in the postoperative post-anesthetic care unit (PACU). did. their work is pro swan.

“The increasing amount of time people are spending at keyboards coupled with an aging population is projected to increase the need for common elective hand surgery.” Department of Anesthesiology, Critical Care and Pain Medicine at BIDMC. “There is definitely a need to change anesthesia practices to optimize the care of these patients. It’s about providing an immersive experience that can distract you.”

O’Gara et al. enrolled 34 adults who underwent hand surgery with local anesthesia at BIDMC between December 2018 and August 2019. Patients undergoing VR donned a headset and noise-cancelling headphones and chose their preferred programming from several immersive 360-degree VRs. Environments designed to promote relaxation and tranquility, including meadows, forests and mountain peaks. For both groups, additional anesthetics and/or analgesics can be administered at the discretion of the anesthesia provider on patient request or according to clinical judgment. Neither group had an assigned investigator to provide anesthesia for study participants, nor were any members of the study team present in the operating room to perform research activities on patients in the control group. .

Scientists’ results reveal that patients in the VR group received significantly less propofol than patients in the control group, with a median of 260 mg less propofol per patient than patients in the normal treatment group became. Notably, only 4 of her 17 patients in the VR group received propofol during the procedure, whereas all patients in the control group received sedation. However, significantly more patients in the VR group received additional local anesthesia by the surgeon than in the control group, suggesting that preoperative nerve blocks are critical to the success of the VR technique.

Follow-up questionnaires administered in the PACU after surgery showed no significant difference in overall satisfaction between the VR and control groups, based on patient self-reported results. Additionally, patients in both groups said they felt well controlled and relaxed during the procedure. His PACU pain scores, perioperative opioid doses of groups also did not differ significantly. Surprisingly, however, the VR group discharged him from the PACU after surgery on average 22 minutes earlier than the control group. At 1 month after surgery, no differences in functional outcomes related to hand function were found between groups.

O’Gara, who is also an assistant professor of anesthesiology at Harvard Medical School, said: “Using VR immersion avoids potential harm from unnecessary sedation without compromising patient comfort during hand surgery. Additionally, patients in the VR group spent 22 minutes longer than control patients. We found that we were discharged from the PACU earlier, and if VR technology becomes more widely used, reducing PACU length of stay may help optimize perioperative efficiency.”

Co-authors include First and Lead Author Adeel A. Faruki from University of Colorado Hospital. BIDMC’s Nadav Levy, Sam Proescel, Valerie Banner-Goodspeed and Tamara D. Rozental. Thy B. Nguyen of the University of Colorado School of Medicine. Doris Vanessa Gasanwa of St. George’s University School of Medicine. Jessica Yu of Case Western Reserve University School of Medicine. Victoria Ip of the Nova Southeastern School of Osteopath Medicine. Marie McGourty of the University of Massachusetts Boston. Galina Korsunsky of Spectrum Healthcare Partners. Victor Novak of Soroka University Medical Center. Ariel L. Mueller of Massachusetts General Hospital.

This work was funded by the American Society of Anesthesiology Foundation for Anesthesia Education and Research Guidance Research Training Grants. XRHealth provided free access to the software and hardware required for the trial. Additional support for investigator time, research personnel, and equipment was provided by the BIDMC Center for Anesthesia Research Excellence.

O’Gara is a consultant at Sedana Medical. Korsunsky is in commercial partnership with Spectrum Healthcare Partners as an employee. All other authors reported no conflicts of interest.