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Virtual reality pain mitigation during elective cesarean surgical delivery

2019 , Mosso Vázquez, José Luis , Mosso Lara, Dejanira , Lara Vaca, Verónica , Wiederhold, Brenda K. , Miller, Ian , Rivas, Homero , Wiederhold, Mark D.

We present supplemental virtual reality (VR) relaxation to reduce pain and anxiety during elective cesarean delivery in 4 young women under epidural analgesia. Methodology. Four women voluntarily participated in a VR relaxation group (mean age = 28.5 years) and four women in a control group (mean age = 30.5 years). VR relaxation was initiated for the placement of the epidural block and cesarean procedure until the gynecologist extracted the newborn from the uterus. The mothe's vital signs and pain were measured using physiological monitoring and a visual analog scale before, during and after anesthesia placement and during and after cesarean surgery. Participants viewed an ‘Enchanted Forest’ virtual environment. Three of the four patients’ husbands participated by navigating the virtual environment for his wife using a game controller. Results. Patients presented 91.89 % pain reduction in the VR group—a remarkable result under regional anesthesia. Patients in the control group presented 61 % increases in pain. Conclusions. VR supplemented pain mitigation provides high levels of satisfaction to mothers during elective cesarean delivery and carries no risk for the newborns. The current report highlights an innovative contribution to womens’ healthcare. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

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Cyborg mini-trainer

2009 , Mosso Vázquez, José Luis , Nieto, Jesús J. , Carbajal, Manuel F. , Marmolejo, Jorge , Ochoa, Enrique , Fuente, Mireya De La , Almazan, Andrew , Obrador, Gregorio

We present the smallest surgical trainer with a total weight of 400 gr, built in aluminum of 25 cm large and 24 cm wide, and 23 cm high. It's a system integrated by a small and open module, a lamp and a microcamera connected to a Head Mounted display. It holds two endoscopic instruments, and items to make knots or sutures and enhance visual-motor coordination. The vision we got is by a small microcamera displayed to a Head Mounted Display HMD. This surgical trainer is the smallest in the worldwide, easy to install, and easy to carry.

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Open surgery while wearing night vision goggles

2010 , Mosso Vázquez, José Luis , Stetz, Melba C. , Gonzalez-Ojeda, Roberto , Wiederhold, Brenda K. , Arrellín Rosas, Gerardo , Rodríguez Schlögl, Elizabeth María , Mosso Lara, Dejanira

Night vision technology is nothing new. In fact, the military rely significantly on this technology during nighttime operations. A surgeon is like a medical soldier in the battlefield. His/her only mission is that of keeping people alive. Due to many technological advances, patients cannot only train on relaxation while visiting their doctors but also get distracted by playing videogames while waiting for them. Furthermore, this virtual reality experience can be enhanced if the patient wears goggles or Head Mounted Displays under dimmed or absence of lights. The purpose of this study was to test if a surgeon could operate when extending into such a dark condition situation, but in the surgical suite. Therefore, a surgeon performed seven open surgeries on rabbits. All surgeries were performed on the thorax and abdomen regions. Specifically, the surgeon was able to perform these surgeries by wearing on his head a micro camera with infrared light and a night vision goggles. The first assistant used this same system while the scrub nurse and the anesthesiologist did not. There were no complications either during or after these procedures. It is possible to make open surgeries wearing a night vision system. Further approaches should be tested with human volunteers. Keywords: Night Vision Goggles, Open Surgery, Cyber-medicine

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Pain Distraction During Ambulatory Surgery: Virtual Reality and Mobile Devices

2019 , Mosso Vázquez, José Luis , Mosso Lara, Dejanira , Mosso Lara, José Luis , Miller, Ian , Wiederhold, Mark D. , Wiederhold, Brenda K.

Virtual reality (VR) pain distraction has been applied across medical, surgical, and behavioral healthcare domains, marking a shift in pain attenuation practices. However, there is little research that has been performed to compare the efficacy of traditional head-mounted displays (HMDs) versus portable VR devices. The present study evaluated 44 outpatients in need of lipoma resection. Randomized into two groups—HMD versus mobile phone VR—participants navigated pain distraction virtual environments while undergoing surgery. Vital signs and subjective pain measurements via a visual analog scale were taken before, during, and after the surgery. Results indicate that the HMD group reported greater pain reduction than the Mobile group. Overall, this study points to the efficacy of nonpharmacological pain attenuation practices. Although both systems reduced pain during surgery, the clinically validated VR environments seen in the HMD group were more effective. This study does show that inexpensive solutions can work in surgical settings. Future research should be performed to identify the most effective VR pain distraction systems.

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Using Cybertherapy to Reduce Postoperative Anxiety in Cardiac Recovery Intensive Care Units

2013 , Mosso Vázquez, José Luis , Santander, Amador , Mosso Jr., José Luis , Gao, Kenneth , Wiederhold, Brenda , Wiederhold, Mark D.

Surgical anxiety creates psychological and physiological stress, causes complications in surgical procedures, and prolongs recovery. Relaxation of patients in postoperative intensive care units can moderate patient vital signs, reduce discomfort, and shorten length of stay. This study explores the use of virtual reality cybertherapy to reduce postoperative distress in patients that have recently undergone cardiac surgery. Twenty-two patients were monitored at IMSS La Raza National Medical Center within 24 hours of cardiac surgery. Patients navigated through a 30-minute virtual reality simulation designed for pain management and stress reduction. Results were analyzed through comparison of pre- and post-operative vital signs and Likert scale survey data. Likert test data showed that 21 of 22 subjects reported less discomfort after navigating through the virtual environment. Physiological data generally supported the Likert data, with 64% of patients lowering respiratory rate, moderated blood carbon dioxide levels, and decreased diastolic blood pressures in another 64% of patients. Thus, due to the innocuous and non-invasive nature of cybertherapy, virtual reality demonstrates promise in reducing postoperative anxiety.

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Cybertherapy in medicine - Clinical applications to reduce pain and anxiety

2013 , Mosso Vázquez, José Luis , Golsong, Jean-Baptiste , Wiederhold, Mark D.

From the beginning of the 21st century, many authors have analysed and published reports on the benefits of applying virtual reality to medicine within clinical procedures. Whether it is for traumatic head injuries, burn wound care, lumbar punctures, or during chemotherapy treatment for children, virtual reality has many applications. The first published case report relating to the use of virtual reality within an invasive medical procedure was in 2004 by our group, beginning with upper gastrointestinal endoscopies and so on, until the introduction of virtual reality (VR) in a postoperative care unit of cardiac surgery. The end goal of this project is to demonstrate that virtual reality is a complementary tool to reduce pain and anxiety in hospitals during medical procedures including surgical procedures. Copyright © Cybertherapy and Rehabilitation Magazine. All Rights Reserved

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Emotional Response to Virtual Reality Exposure across Different Cultures: The Role of the Attribution Process

2009 , Gorini, Alessandra , Mosso Vázquez, José Luis , Mosso, Dejanira , Pineda, Erika , Ruíz, Norma Leticia , Ramírez, Miriam , Morales, José Luis , Riva, Giuseppe

Many studies have shown the ability of media—television, movies, and virtual reality (VR) experiences—to elicit emotions. Nevertheless, it is still unclear how the different factors involved—user related and medium related—play a role in producing an emotional response during a VR experience. We investigate this issue, analyzing the role played by the cultural and technological backgrounds of the users in the emotional responses to VR. Specifically, we use the “core affect” model of emotions developed by Russell (2003) to explore how these factors influence the way in which participants experience virtual worlds. Our sample includes 20 Mexican participants: 8 living in El Tepeyac, a small rural and isolated Mexican village characterized by a very primitive culture, and 12 high civilized inhabitants of Mexico City. The “Green Valley,” a noninteractive, relaxing immersive environment showing a mountain landscape around a calm lake, was used to induce relaxation in the two groups during an ambulatory surgical operation. To investigate the effects of VR on the relaxation process, we measured participants' physiological (heart rate) and emotional (VAS-A) responses before, during, and after the operation. The results show that VR significantly modified the core affect (reduced arousal) in all participants but that the final emotional response produced by this change was influenced by the attribution process: the civilized inhabitants of Mexico City, who were able to attribute the reduced arousal to the VR experience, reported a significant reduction in the self-reported level of anxiety, while people from El Tepeyac showed a reduction in their physiological reactions but not in their perceived anxiety.

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Pain reduction with VR in indigenous vs urban patients in ambulatory surgery

2019 , Mosso Vázquez, José Luis , Obrador, Gregorio , Moss Lara, Dejanira , Mosso Lara, José Luis , Wiederhold, Brenda K. , Lara Vaca, Verónica , Miller, Ian , Wiederhold, Mark D. , Michael, Aaron , Lange, John , Yu Gillette, Sean

The current report presents comparisons of pain reduction and heart rate response using supplemental virtual reality (VR) pain distraction between 22 indigenous and 22 urban patients during ambulatory surgery. Material and methods. Forty-four (44) patients participated under full informed consent. Half (n = 22) were indigenous peoples and half (n = 22) were urban patients (those residing in Mexico City). For the urban group, a surgeon performed ambulatory surgeries with local anesthesia to remove lesions in soft tissues, such as lipomas, cysts located in the head, neck, back, shoulders, arms, limbs, and abdomen. For the indigenous group, operating rooms, intravenous line, analgesics, and sedatives were not used. Materials included laptop-linked virtual reality, PlayStation, Smartphones and Google Cardboard googles alongside virtual environments such as Enchanted Forest, The Sea, Lake Valley, Jurassic Dinosaur and Coast Space VR. Results. Pain scale indicated 2.92 before, 1.67 during and 0.67 after for indigenous participants, and 5.8 before, 3.32 during and 1.48 after for urban participants. Heart rate responses in indigenous were 80.42(before), 78.5 (during) and 72.42 (after) and urban responses were 74.07 (before), 68.53 (during) and 73.1(after). Discussion. Indigenous patients presented more pain reduction during ambulatory surgery without intravenous lines, analgesics or sedatives and required recovery time or hospitalization. Supplemental VR during medical and surgical procedures is discussed in light of cultural, economic and psychological variables associated with medical care in Mexico. ©2019, Interactive Media Institute. All rights reserved.

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Cybertherapy in Medicine – Experience at the Universidad Panamericana, IMSS and ISSSTE Mexico

2012 , Mosso Vázquez, José Luis , Wiederhold, Brenda , Wiederhold, Mark , Obrador, Gregorio , Lara, Verónica , Santander, Amador

There are many reports of Virtual Reality analysis and clinical applications in Medicine since the end of the last century for many authors. In trauma head injuries [1], during chemotherapy in children [2], in burn wound care [3,4,5], lumbar puncture [6,], breast cancer [7], vein puncture [8], pain distraction [9,10,11,12], dental pain control [13], leg ulcer relief [14], night vision technology with robot control to treat bourn injuries using robot-like arm mounted VR goggles [15]. The first case reports related with VR and medical invasive procedures and surgery in hospitals was in 2004 with our group, beginning with upper gastrointestinal endoscopies and so on, until introduce VR in postoperative care unit of cardiac surgery [16,17]. Pain and anxiety in outpatients and inpatients is a regular symptom in hospitals. For pain are available medications and for anxiety also. Patients in; in-rooms, operating rooms and another different places, get treatments with medical and surgical procedures, and pain and anxiety are the meanly symptom. In this project we try to demonstrate that virtual reality is a complementary tool to reduce pain and anxiety in hospitals during medical procedures including surgical procedures. There are a lot reason and justifications to use VR in hospitals, as follows. Neonatology (0-28 days old), there are newborns staying in unit cares since few days, weeks even months, growing without contact with the external world. The visit unit care is limited to parents in few hours a day. The psychological impact in growth and development in childhood is so hard, where neuro stimulation in a closed environment is a good alternative. In Infants (lower and higher infants) VR have been a good resource to reduce pain and anxiety in oncology. Hunter Hoffman has demonstrated in the benefits of VR during medical rehabilitation in burned childhood. In postoperative cardiac surgery unit care, patients stay 3 days in different critical care units depending of their progress. In these units they stay under the influence of sedative drugs receiving treatments by vein catheters, gastric tube, etc. Their recovery is on beds with different degrees of limited position and the breathing relief is on bed also. In ambulatory surgery (General surgery, endoscopic surgery, urology, dermatology, Orthopedic, angiology, pediatric surgery, obstetrics), patients are awake, minutes, even hours awake during surgical procedures doing nothing in a same position on a surgical table. In the recovery they stay hours waiting for go home or to be hospitalized. Special group of ambulatory surgery, surgeon used night vision technology while patients navigate in VR environment. At the school of medicine from Universidad Panamericana we used night vision on animal models before the application on humans. Gynecology and obstetrics. Women during colposcopy are awake while gynecologist applies local anesthesia into the cervix to perform cervical conization with diathermal loop. The anxiety is present in a same gynecological position. Gastrointestinal endoscopy. Under local anesthesia, neurovegative response is present during and after each upper gastrointestinal exploration of esophagus, stomach and duodenum. Patients present plenty of saliva associated with shortness of. Labor Room. Pregnant patients without complications expected hours to complete cervical dilation in labor room to go into delivery room or operating room. During uterus contractions they increase their respiratory rate. Pediatric. Scholar children stay on bed many days in recovery. In their stay they distract with games and in some times with a TV only. Epidural and Spinal block in anesthesia. This is a relative fast procedure compared with the previous groups where patient in the fetal position they expect catheter installation in their back, place where they can´t see anything and anxiety is present despite local infiltration.

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Virtual reality and minimal analgesia attenuate pain during spine surgery

2019 , Mosso Vázquez, José Luis , Canseco Aguilar, Patricia , Mosso Lara, Dejanira , Miller, Ian , Wiederhold, Brenda , Wiederhold, Mark D.

We present progress with 17 cases of virtual reality (VR) therapy to reduce pain and anxiety during interventional treatment under radiology guidance on patients diagnosed with intense and chronic back pain with narrow channel syndrome and lumbar disc hernias. Methodology. Patients under informed consent fitted with a head mounted display (HMD), to allow them to navigate in VR scenarios, lie in a prone position. The procedure begins using minimal analgesia with an intravenous single dose with fentanyl 50 mcg without sedation. We infiltrate locally with local anesthesia (lidocaine 1%); depending on the interventional procedure involved. The interventional procedures were: discography with discolysis with ozone, caudal blockages, and foramina blocks. During the procedure, patients navigate VR scenarios created at the Virtual Reality Medical Center in San Diego (Dr. Brenda Wiederhold). At the end of the procedure, patients recover for one to two hours before leaving the Surgical Center. Results. No statistically significant increase in pain ratings from baseline through procedure were noted, however, a significant decrease was noted post-operatively. The attenuation of pain due to VR distraction in 17 patients allowed the procedure to be non-sedative (Midazolam was not used). Conclusions. Advantages of VR therapy include a high degree of patient satisfaction, minimal risk without sedatives, such as midazolam, maintenance of patient's conscious awareness, stress reduction in the patient, stress reduction in the anesthesiologist, and cooperation with the patient. The noninvasive VR equipment used is portable, reliable, and led to a a better patient–physician relationship. VR therapy during pain treatment is an excellent option in the pain clinic. Chronic pain treated with anti-inflammatories administered directly to the spine and local ozone is an area in which the use of VR can significantly reduce pain. With this experience we demonstrate the cost benefit advantage that also offers satisfaction to patients while offering savings to health institutions. No complications were presented.