Comparative Efficacy of Video Games Versus Midazolam in Reducing Perioperative Anxiety in Pediatric Patients: Systematic Review and Meta-Analysis.

Summary

Across 6 randomized trials (n=612), video game interventions reduced anxiety versus oral midazolam during parent separation (SMD -0.31; high certainty) and mask induction (SMD -0.29; moderate certainty), improved postoperative behavior, and shortened PACU stay by ~19 minutes. No difference was found for emergence delirium.

Key Findings

• Anxiety reduced versus midazolam during parent separation (SMD -0.31, 95% CI -0.50 to -0.12; P=.001; high certainty).
• Anxiety reduced during mask induction (SMD -0.29, 95% CI -0.52 to -0.05; P=.02; moderate certainty).
• Improved postoperative behavior (SMD -0.35, 95% CI -0.62 to -0.09; P=.008) and shorter PACU length of stay (MD -19.43 minutes, 95% CI -31.71 to -7.16; P=.002); no significant difference in emergence delirium.

Clinical Implications

Consider integrating age-appropriate video game interventions as first-line or adjunct anxiolysis in preoperative workflows to reduce benzodiazepine use and PACU times, while monitoring emergence delirium via standard protocols.

Limitations

• Only six RCTs; heterogeneity in game content, timing, and anxiety scales
• Moderate certainty for some outcomes; limited data on long-term behavior and resource utilization

Future Directions

Head-to-head pragmatic trials comparing digital interventions versus benzodiazepines across diverse pediatric settings; cost-effectiveness and implementation science evaluations; personalization by age and neurodevelopmental status.