Effect of yoga-based breathing and relaxation regimen on preoperative anxiety and neurological biomarkers in neurosurgical patients: A prospective randomized controlled trial

Preoperative anxiety, affecting 17% to 89% of brain surgery patients, can result in longer hospital stays, depression, increased physical disability, reduced quality of life, and impaired cognitive functions. Conventional antianxiety drugs like opioids and benzodiazepines worsen the problem by causing hypoventilation and raising intracranial pressure. This has led to a focus on nonpharmacological interventions that avoid these adverse effects. Yoga is a promising therapeutic tool for managing physical, psychological, and psychosomatic disorders. Studies in cardiac surgery patients and breast cancer survivors have demonstrated the efficacy of yoga-based lifestyle programs and breathing exercises. Yoga has been linked to physiological and biochemical benefits.

This study explores the potential benefits of incorporating yoga-based breathing and relaxation techniques into the perioperative care of neurosurgical patients. We hypothesize that neurosurgical patients scheduled for elective supratentorial tumor excision who practice yoga-based breathing exercises for about five days preoperatively will experience reduced preoperative anxiety compared to those who do not. Research Question: Does a short-term yoga-based

breathing regimen reduce preoperative anxiety in neurosurgical patients compared to those who do not practice yoga? Primary Objective: To determine the effect of a short-term yoga-based breathing regimen on preoperative anxiety,

using the State-Trait Anxiety Inventory (STAI). Secondary Objective: To determine the impact of an extended yoga-based

breathing regimen, continued into the postoperative period, on neurological biomarkers such as glial fibrillary acidic protein (GFAP), neurofilament light (NfL), S100B and brain-derived neurotropic factor (BDNF), and to explore the feasibility and adherence of supervised tele-yoga sessions in perioperative care of neurosurgical patients. This prospective randomized controlled trial will be conducted on 80 patients (40 in each group) in the Neurosurgical wards of Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow. The study will include adult

patients (aged 18-65 years) scheduled for elective craniotomy and excision of supratentorial tumors under general anesthesia. The study will include ASA I or II patients who are conscious and oriented. Patients unwilling to consent, those

with significant mass effect or tumor-induced seizures, severe pulmonary or coronary artery disease, smoking or alcohol abuse, psychiatric disorders, emergency surgeries, and significant skeletal or joint disorders will be excluded. Group Y (Yoga) patients will receive yoga-based breathing and relaxation regimes for at least five days before surgery and Group C (Control) patients will not receive yoga interventions while receiving usual medical care. A night before surgery, anxiety scores (STAI) will be assessed in all the patients (Primary outcome). At six weeks of discharge, GFAP, NfL, S100B and BDNF will be measured.