المتخصصون في المجالات الطبية

March 21, 2025

What if patients could ease their preoperative anxiety with the help of on-site technology? A new study suggests in-hospital use of virtual reality (VR) prior to open-heart surgery can reduce a patient's anxiety. Mayo Clinic cardiovascular researchers and surgeons found that a single exposure to immersive VR significantly reduces preoperative patient anxiety and improves overall patient preoperative experience. The findings were published in Mayo Clinic Proceedings.

"This research was the first to use a randomized, controlled trial to determine whether immersive virtual reality effectively reduced preoperative anxiety in patients undergoing first-time cardiac surgery," says John M. Stulak, M.D., a cardiovascular surgeon at Mayo Clinic in Rochester, Minnesota, and one of the study's authors.

Alternative to medication

The research addressed a need to offer another approach for easing patients' preprocedural anxiety. The use of antianxiety medication may not be helpful for some patients before surgery. "Undergoing first-time cardiac surgery is one of the most stressful events a patient can undergo, and many patients are anxious the morning of surgery. Recent studies suggest that pharmacological anxiolytics, drugs that reduce anxiety, can increase difficulty of intubation and prolong time to extubation in some patients," says Dr. Stulak. The medication given presurgery also has been associated with adverse respiratory events, transient postoperative cognitive dysfunction and other undesirable perioperative outcomes.

Instead of medication, immersive VR can be an effective tool for reducing anxiety prior to cardiac surgery and ease the discomfort of preoperative steps such as IV placement. Recent research strongly suggests that heightened levels of preoperative anxiety worsen a patient's experience and is linked to:

• Lower levels of daily activity following surgery.
• More postoperative pain.
• Increased use of pain medication after surgery.

"This study represents a first step in identifying ways to use nonpharmacological methods to effectively reduce anxiety in patients undergoing surgery," says Dr. Stulak. "Given that our immersive VR intervention effectively reduced anxiety in this high-stress environment, our surgical practice is now exploring ways to effectively implement this on a broader scale throughout a patient's surgical episode and evaluate its effectiveness on clinical outcomes."

Study highlights

The study included 100 patients scheduled for open-heart surgery. Patients wore a monitor to record vital signs. They also took a standardized, clinically validated anxiety test, answering questions before and after the VR intervention. Through VR, participants experienced 10 minutes of nature with guided breathing and views of trees and waterfront that changed through four seasons. The technology reduced patients' pulse rates. It did not affect respiration rate or oxygen levels.

The researchers tested two forms of intervention aimed at reducing anxiety prior to cardiac surgery — immersive using VR goggles and nonimmersive using an electronic tablet. "We found that exposure to either intervention reduced overall anxiety prior to cardiac surgery, although the VR intervention tended to have more consistent effectiveness. Most patients felt the immersive nature of VR goggles helped them focus and relax to a greater extent, and with fewer distractions," says Dr. Stulak. "For the subset of patients who experience motion sickness with VR interventions, the tablet content can be an effective and well-tolerated alternative."

Next steps

The findings build upon Mayo Clinic Cardiovascular Surgery's long-standing tradition of exploring innovative ways to reduce patient stress while improving patient care and experience. "We are currently exploring ways to launch a broader implementation effort to make this technology available to all patients undergoing cardiac surgery at Mayo Clinic, and potentially to patients during in-hospital, postoperative recovery," says Dr. Stulak.

There is also an interest in seeing how the interventions can help reduce anxiety for family members who are waiting at the hospital during the surgical procedure. "Ultimately, we believe that reducing stress and anxiety for both patients and their loved ones is critical for effective care delivery, optimal communication and the best possible surgical experience at Mayo Clinic," says Dr. Stulak.

The cardiovascular team plans to work with first-in-class enhanced biofeedback and generative AI modules currently in development. "This will enable an individualized VR experience with maximized effectiveness for each patient," says Dr. Stulak. "It's an exciting time for the application of cutting-edge technologies to improve patient experiences and outcomes."

For more information

Subramaniam T, et al. A randomized, controlled trial of in-hospital use of virtual reality to reduce preoperative anxiety prior to cardiac surgery. Mayo Clinic Proceedings. 2025;100:220.

Refer a patient to Mayo Clinic.