Immersive virtual reality familiarisation with the operating theatre versus verbal flip-chart education for preoperative anxiety before third molar surgery under general anesthesia: a randomized controlled trial

Background Unfamiliarity with the operating theatre contributes to preoperative anxiety before general anesthesia. This trial evaluated whether a 360-degree virtual reality familiarisation with the operating theatre reduces preoperative anxiety compared with conventional verbal education in adults undergoing third molar surgery under general anesthesia. Methods In this single-centre, parallel-group randomized controlled trial, 32 adults aged 18–40 years (American Society of Anesthesiologists physical status I–II, no previous general anesthesia) scheduled for removal of at least two impacted third molars were allocated by coin toss to virtual reality (n = 16; 360-degree video of the pathway from theatre entry to induction) or verbal education supported by a flip chart (n = 16) on the day before surgery. The Amsterdam Preoperative Anxiety and Information Scale, salivary alpha-amylase and cortisol (enzyme-linked immunosorbent assay), blood pressure, pulse rate and respiratory rate were measured before, immediately after and 15 minutes after the intervention. Between-group comparisons used the independent t-test or Mann–Whitney U test; within-group changes used repeated-measures analysis of variance or the Friedman test. Results In the virtual reality group, anxiety scores decreased from 18.88 ± 5.15 to 16.75 ± 4.95 and 16.38 ± 5.04 (p = 0.043); in the control group they decreased from 20.00 ± 4.60 to 18.13 ± 4.47 and 16.81 ± 5.37 (p = 0.067). Scores did not differ between groups at any time point (15 minutes after the intervention: mean difference − 0.43, 95% confidence interval − 4.19 to 3.33; p = 0.814). Salivary alpha-amylase, cortisol, systolic and diastolic blood pressure, pulse rate and respiratory rate did not differ between groups at any time point and did not change significantly within either group (all p > 0.05). Conclusions A brief virtual reality familiarisation with the operating theatre was followed by a significant within-group reduction in self-reported preoperative anxiety but was not superior to verbal flip-chart education, and neither approach changed salivary stress biomarkers or vital signs. Virtual reality may serve as an adjunct to, rather than a replacement for, conventional preoperative education; larger trials are warranted. Trial registration: Thai Clinical Trials Registry TCTR20261003001. Registered 3rd October 2026. Retrospectively registered.