Immersive virtual reality familiarisation with the operating theatre versus verbal flip-chart education for preoperative anxiety before third molar surgery under general anesthesia: a randomized controlled trial

Before a major surgery, many people feel a knot of worry in their stomach. This is not just nervousness about the pain or the procedure itself; for many, it is the fear of the unknown. They have never seen the place where they will be put to sleep, and they do not know the sequence of events that will happen from the moment they walk through the door until they lose consciousness. This unfamiliarity can trigger a physical stress response, raising heart rates and blood pressure, which can make the actual surgery more difficult and the recovery slower. Doctors have long known that giving patients clear information helps calm these fears, but the question remains: does simply talking about the process work as well as letting patients experience it?

In recent years, technology has offered a new way to bridge this gap. Virtual reality allows a person to step inside a digital version of a place, seeing and hearing everything as if they were really there. In the world of medicine, researchers have begun to test whether this immersive experience can lower anxiety more effectively than traditional methods. The goal is to find a way to prepare patients so that when they arrive for their operation, they feel less like strangers in a strange land and more like people who know exactly what to expect.

A team of researchers in Indonesia set out to test this idea with a specific group of patients: young adults scheduled to have their wisdom teeth removed under general anesthesia. For many of these healthy individuals, this would be their first time entering an operating room. The researchers wanted to see if a virtual tour of the theater would calm them down better than a standard conversation with a doctor using a picture chart. They recruited thirty-two adults, all between the ages of eighteen and forty, who were scheduled to have at least two impacted wisdom teeth removed. None of them had ever undergone general anesthesia before.

The study was designed as a direct comparison. On the day before their surgery, the patients were split into two groups. One group sat in a quiet room and watched a thirty-six0-degree video of the operating theater. Using a headset that covered their eyes and ears, they experienced a first-person journey from the moment they entered the theater suite, through the preparation room, onto the operating table, and finally to the moment they were put to sleep. The video showed exactly what they would see and hear, narrated in their native language, and lasted fifteen minutes. The other group received the same information, but in a traditional way. They sat with a researcher who showed them a flip chart with photographs of the same rooms and explained the same sequence of events, also taking fifteen minutes.

To measure how well these methods worked, the researchers looked at two different kinds of evidence. First, they asked the patients to rate their own feelings of anxiety using a standard questionnaire that asked about their worries regarding anesthesia and surgery. Second, they looked for physical signs of stress. They collected saliva samples to measure levels of stress hormones, specifically alpha-amylase and cortisol, which are chemicals the body releases when it is under pressure. They also checked the patients' blood pressure, pulse, and breathing rate. These measurements were taken before the intervention, immediately after, and fifteen minutes later.

The results showed that both groups felt better after their session. In the group that watched the virtual reality video, the average anxiety score dropped from nearly nineteen to about sixteen. In the group that looked at the flip chart, the score also dropped, from twenty to roughly sixteen. While the virtual reality group showed a statistically significant drop in their own reported anxiety, the group using the flip chart showed a similar, though slightly less consistent, improvement. When the researchers compared the two groups directly, they found no meaningful difference between them. The virtual reality experience did not calm the patients down any more than the simple conversation with pictures did.

Perhaps more surprising was the lack of change in the body's physical response. Despite the drop in how worried the patients said they felt, their stress hormones did not change. The levels of cortisol and alpha-amylase in their saliva remained the same, and their heart rates, blood pressure, and breathing patterns stayed within normal ranges. This suggests that while the patients felt more at ease mentally, their bodies did not register a significant shift in stress. The researchers noted that this disconnect between what people feel and how their bodies react is a known phenomenon, but it highlights that feeling calm does not always mean the body has stopped reacting to the threat of surgery.

The study also confirmed that the virtual reality method was safe and feasible. No one experienced dizziness, nausea, or other side effects from wearing the headset, and the infection control measures, such as using disposable masks under the device, worked well. However, the researchers were careful to point out that their study was small, involving only sixteen people in each group. Because of this small size, they could not definitively prove that virtual reality is no better than the flip chart, only that they did not find a difference in this specific group. They also noted that the measurements were taken only fifteen minutes after the session, which might have been too soon to catch any delayed changes in stress hormones.

Ultimately, the study suggests that virtual reality is a useful tool that can be added to the standard preparation for surgery, but it is not a magic replacement for talking to a patient. For young adults facing their first general anesthesia, a simple, clear explanation using pictures works just as well as an immersive digital tour in reducing their reported anxiety. The researchers concluded that while the technology is promising and feasible, larger studies are needed to see if these methods can improve the actual physical outcomes of surgery, such as stability during the operation or speed of recovery. For now, the best approach appears to be using whatever method makes the patient feel most informed and comfortable, whether that is a high-tech headset or a well-organized picture book.