Comparison of the Effectiveness of Virtual reality and Midazolam Premedication on Preoperative Anxiety and Hemodynamic Changes in Patients Undergoing Elective Surgery

Abstract

Background: Preoperative anxiety is a common condition experienced by up to 80% of patients undergoing elective surgery. This condition not only has psychological impact but also triggers physiological changes that may affect hemodynamic stability and anesthetic outcomes. While midazolam is an effective pharmacological premedication to reduce anxiety, it carries respiratory and cognitive side effects. Virtual reality (VR) has emerged as a non-pharmacological alternative that offers distraction effects through immersive multisensory experiences. This study aims to compare the effectiveness of VR to midazolam in reducing preoperative anxiety and maintaining hemodynamic stability. Methods : This study was designed as a randomized controlled trial involving 30 patients aged 18–45 years, ASA physical status I–II, who underwent elective surgery under spinal anesthesia. Subjects were divided into two groups: the VR group (n=15) and the midazolam group (n=15). Anxiety levels were measured using the Amsterdam Preoperative Anxiety and Information Scale (APAIS) at baseline and after intervention. Hemodynamic parameters—including systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate—were recorded at baseline, 5 minutes, and 30 minutes after intervention. All data were statistically analyzed. Results : Analysis demonstrated a reduction in APAIS score 30 minutes after intervention in the VR group compared to baseline. A similar result was observed in the midazolam group. However, comparison between the VR and midazolam groups revealed no significant difference in the reduction of preoperative anxiety at the 30-minute evaluation (p>0.05). Likewise, changes in hemodynamic parameters (systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate) measured at baseline, 5 minutes, and 30 minutes showed no significant differences between the two groups (p>0.05). Conclusion : Both interventions effectively reduced preoperative anxiety, but their effectiveness was equivalent as no difference was found. Hemodynamic changes were also not different between the two groups.