Background: Sedation protocols during spinal anesthesia often involve sedative drugs associated with complications, including respiratory depression. Recently, virtual reality (VR) has been evaluated for its clinical applications. We investigated whether VR distraction could by applied and yield a better satisfaction than pharmacological sedation during spinal anesthesia.
Methods: VR distraction without any sedative was compared with pharmacological sedation using repeated 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. Other sedation profiles were compared.
Results: Thirty-seven patients were randomized to the VR group (n = 18) or sedation group (n = 19). Anesthesiologists’ satisfaction score was significantly higher in the VR group than in the sedation group (median [interquartile range] 5 [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 good (kappa = 0.874 and 0.944, respectively). The incidence of apnea was significantly higher in the VR group than the sedation group (n=1, 5.6% vs. n=7, 36.8%, p = 0.042).
Conclusions: The present findings suggest that VR distraction is better than drug sedation with midazolam in terms of patients’ and anesthesiologists’ satisfaction and avoiding the respiratory side effects of midazolam during urologic surgery under spinal anesthesia.