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Level of sedation may influence effect of virtual reality glasses during distraction therapy.

In “Effects of Distraction Using Virtual Reality (VR) Glasses During Lumbar Punctures in Adolescents With Cancer” by Suzanne Sander Wint, RN, BSN, CPON, Debra Eshelman, RN, MSN, CPNP, Jill Steele, RN, MSN, and Cathie E. Guzzetta, RN, PhD, HNC, FAAN, an Online Exclusive article in the January/February (2002) issue of the Oncology Nursing Forum (ONF) (Vol. 29, pp. E8–E15), the authors’ use of virtual reality glasses as a distraction measure during lumbar punctures was a creative way to help manage patients’ pain. However, some aspects of the research influenced my acceptance of the clinical significance of the findings. Although the use of fentanyl, midazolam, and EMLA cream (AstraZeneca Pharmaceuticals, LP, Wilmington, DE) were controlled variables in the study, I wondered if this pharmacologic therapy influenced the patients’ perception of pain. As an emergency department nurse, I have performed conscious sedation many times and know that pharmacologic therapy affects people differently. In the study by Wint et al. (2002), the Sedation Assessment Scale was used only after the procedure was completed. The level of sedation during the procedure was not included in the study. Because of this, I wondered if the sedative effects of pharmacologic therapy increased the patients’ distractibility and made the VR glasses seem more effective. Rosen and Rosen (1998) found that IV midazolam used in combination with opioids or other sedatives significantly increased amnesia immediately following procedures. Amnesia tended to occur more frequently in children older than 11 years than in those younger than 11. Therefore, the patients in the Wint et al. study may have reached a level of sedation where they experienced some amnesia during the actual procedure. The Wint et al. (2002) study had points that can be expanded by future research using a larger sample population. Patients responded positively to the VR glasses and seemed to enjoy the video shown. Broome, Rehwaldt, and Fogg (1998) stated that relaxation and distraction techniques provide competing stimuli that decrease the strength of signals triggering aversive drive and decrease both physiologic and behavioral distress. Based on patients’ postprocedure responses in the Wint et al. study, the VR glasses achieved this goal and reduced behavioral distress.