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J. Clin. Med. 2019, 8(1), 2; https://doi.org/10.3390/jcm8010002

Virtual Reality Distraction during Endoscopic Urologic Surgery under Spinal Anesthesia: A Randomized Controlled Trial

1
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul 03080, Korea
2
Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
*
Author to whom correspondence should be addressed.
Received: 11 November 2018 / Revised: 12 December 2018 / Accepted: 18 December 2018 / Published: 20 December 2018
(This article belongs to the Section Anesthesiology)
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Abstract

Sedation protocols during spinal anesthesia often involve sedative drugs associated with complications. We investigated whether virtual reality (VR) distraction could be applied during endoscopic urologic surgery under spinal anesthesia and yield better satisfaction than pharmacologic sedation. VR distraction without sedative was compared with pharmacologic sedation using repeat doses of midazolam 1–2 mg every 30 min during urologic surgery under spinal anesthesia. We compared the satisfaction of patients, surgeons, and anesthesiologists, as rated on a 5-point prespecified verbal rating scale. Two surgeons and two anesthesiologists rated the scale and an overall score was reported after discussion. Thirty-seven patients were randomized to a VR group (n = 18) or a sedation group (n = 19). The anesthesiologist’s satisfaction score was significantly higher in the VR group than in the sedation group (median (interquartile range) 5 (5–5) vs. 4 (4–5), p = 0.005). The likelihood of both patients and anesthesiologists being extremely satisfied was significantly higher in the VR group than in the sedation group. Agreement between the scores for surgeons and those for anesthesiologists was very good (kappa = 0.874 and 0.944, respectively). The incidence of apnea was significantly lower in the VR group than in the sedation group (n = 1, 5.6% vs. n = 7, 36.8%, p = 0.042). The present findings suggest that VR distraction is better than drug sedation with midazolam in terms of patient’s and anesthesiologist’s satisfaction and avoiding the respiratory side effects of midazolam during endoscopic urologic surgery under spinal anesthesia. View Full-Text
Keywords: virtual reality; sedation; spinal anesthesia; endoscopic urologic surgery virtual reality; sedation; spinal anesthesia; endoscopic urologic surgery
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    Description: Supplemental Figure 1. Patient during Holmium laser enucleation of the prostate under spinal anesthesia with virtual reality distraction. Supplemental Figure 2. A Screenshot of ‘Aqua 30’ Supplemental Figure 3. A Screenshot of ‘Aqua 30’ Supplemental Figure 4. A Screenshot of ‘Aqua 30’ Supplemental Text 1. Script of ‘Aqua 30’ (Introduction part only) Supplemental Table 1. Satisfaction score. Supplemental Table 2. Modified Aldrete Score.
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Moon, J.Y.; Shin, J.; Chung, J.; Ji, S.-H.; Ro, S.; Kim, W.H. Virtual Reality Distraction during Endoscopic Urologic Surgery under Spinal Anesthesia: A Randomized Controlled Trial. J. Clin. Med. 2019, 8, 2.

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