Preoperative anxiety is very common in children which can lead issues at induction of anaesthesia and gives a traumatic experience to the child and dissatisfaction among parents.

Various pharmacological and non-pharmacological methods have been used to decrease the preoperative anxiety of the child. Among pharmacological methods, drugs such as midazolam, clonidine, and dexmedetomidine have been used via various routes. However, sedatives drugs may lead to some side effects. Non-pharmacological methods are based mostly on distraction tactics. These include merely talking to the child, or use of audio rhymes, cartoon videos etc.

Immersive virtual reality (IVR) is the latest development in technology of such kind and children seem to adapt to it quickly too. Hence we planned this study to evaluate the effect of IVR on decreasing the preoperative anxiety in children in OT with primary aim to compare the effect of immersive virtual reality (IVR) with intranasal midazolam  on change in the preoperative anxiety at inhalational induction of anaesthesia

After pre-anaesthetic check-up a day before surgery, aim and methodology of the study will be informed to parents and children above the age of 6 years and informed consent will be obtained. Child’s anxiety score (mYPAS) (Tp) will be noted. In the same visit, the VR headset will be checked for proper fitting. The child will choose his/her favourite video. On the day of surgery, the child will be randomised into group V or group M. Child’s mYPAS will be noted in the preoperative room. In group V, selected video via  IVR headset will be played in the preoperative room and he/she will be shifted to OT with the headset on and induction of anaesthesia will be done with face mask and inhalational agents while the child is watching the video via headset.In case of group M, 20 minutes prior to shifting to the OT, 0.3 mg/kg midazolam will be spayed into one nostril or divided doses into both nostrils. The child will be transferred to OT on a trolley and induction of anaesthesia will be done, with face mask and inhalational agents. In both groups, a parent or guardian will accompany the child to the OT according to the hospital policy.

The following steps will be common to both the groups. mYPAS scores will be noted a day before in the ward (Tp), before the initiation of intervention(T0), in the preoperative room at 10 minutes after intervention (T1), the time of transport to OT (T2) and during the induction of anaesthesia (T3). Standard ASA monitors will be attached & inhalational induction will be done with incremental increase in sevoflurane concentration in 100% O2, with an appropriately sized face mask. Assessment of Induction compliance checklist (ICC) and Mask acceptance score (MAS) will be done and noted. Insertion of IV cannula will be done once adequate depth of anaesthesia is achieved. Rest of the anaesthesia management including airway management will be at the discretion of the attending anaesthesiologist. Parent’s satisfaction will be assessed after induction of anaesthesia.