Advancement in anaesthesia has brought a revolution in the field of surgery. The invention of gas anaesthesia and newer muscle relaxants has made the surgical procedure much easier. These sophisticated facilities are only available at a few centres in big cities. Even today, open ether anaesthesia remains the only choice in almost all district level hospitals and other rural set-ups in developing countries like India.
The very mention of surgery can throw a patient into great anxiety and tension. He becomes afraid of whether he will die during the anaesthesia or due to complications in the surgery. This anxiety and phobia about surgery prevents a person from accepting and co-operating with the introduction of the anaesthesia and surgical procedures, and it also delays the postoperative recovery. As a result, a greater amount of the anaesthetic agent, such as ether, is required to achieve proper anaesthesia and muscle relaxation. These drugs and anaesthetic agents are not free from the danger of side effects.
The ability of bhramari pranayama in alleviating anxiety and tension is well known; its role in preventing insomnia, correcting nocturnal enuresis in children and treating alcohol and drug addicts has already been established. It lowers blood pressure which has been increased by tension. Bhramari also enables a person to develop confidence and positive thinking towards any situation.
Bhramari pranayama is practised sitting in any comfortable asana. The eyes and mouth are gently closed. The teeth are not touching. The ears are closed, using the index fingers, and with the exhaling breath a humming sound, like that of the bee, is produced. The whole pharynx, nasal cavities and sinuses become a resonating column. This sound produced in the vocal cords travels by bone conduction through the eustachian tube to the middle ear and into the internal ear. This causes the entire cerebral cortex to vibrate. The environment of the whole body is controlled by the combined neuro-endocrinal systems. Therefore, when the cerebral cortex is vibrating the impulses are sent to the hypothalamus which has the capacity to control the pituitary gland - the master of all the glands. In this way, the endocrinal system is controlled and regulated. These impulses from the hypothalamus also affect the sympathetic nervous system which in turn affects all the internal systems of the body.
Bhramari pranayama tunes the regulatory mechanism, both the endocrinal and autonomic nervous system. Therefore, in a patient who is apprehensive about an operation, the sympathetic nervous system can be controlled and the parasympathetic nervous system stimulated to produce a harmonious effect and balance all the internal systems. As anxiety, human mood, behaviour and personality are regulated by the reticular formation, the vibration of bhramari pranayama eliminates the anxiety and improves the patient's mood, behaviour and personality. The vibration of the cortex also eliminates any unusual irritation of the voluntary muscles.
With this information in mind, a study was conducted in the postpartum, obstetrics and gynaecology sections of the district hospital in Munger. The study was to assess the effects of bhramari pranayama in the preoperative and postoperative stages of the various surgical procedures carried out, and also to assess the effects on postoperative recovery.
Preoperative bhramari pranayama was performed for half an hour before surgery in 205 cases of tubectomy, 52 cases of D and G and MTP, 38 cases of caesarean section and 6 cases of hysterectomy and other gynaecological operations. No preoperative sedation or muscle relaxants were given. Bhramari pranayama was again repeated for 2-7 minutes after recovery from the anaesthesia. The control group was made up of 432 cases of tubectomy, 102 cases of D and C and MTP, 46 caesarean section and 8 hysterectomies and other gynaecological operations. The usual preoperative medication and postoperative management was given in these cases. Bhramari was not used.
Bhramari pranayama, practised correctly and with dedication, resulted in sudden changes in the psychology of the patient. The patient in each case was in a relaxed mood compared to the patients of the control group, who were tense and anxious. The patients in the bhramari pranayama group were more self-confident and positive towards the results of the operation than those in the control group. All the patients of the first group were in a relaxed mood, having full confidence in the operation as compared to the immense anxiety and fear shown by those in the control group, who had received preoperative anxiolytic drugs. In the study group the preoperative pulse rate, blood pressure and rate of respiration were at almost normal levels after the practice of bhramari pranayama.
| Nature of Surgery | With Bhramari Pranayama | Without Bhramari Pranayama |
|---|---|---|
| Tubectomy | 90ml | 175ml |
| MTP | 75ml | 200ml |
| D and C | 75ml | 200ml |
| Caesarean Section | 200ml | 450ml |
| Hysterectomy and other operations | 400ml | 600ml |
It was observed that in cases where preoperative bhramari pranayama was practised, the induction of the anaesthesia was quite smooth. The amount of ether required to produce anaesthesia and adequate relaxation of the surgical field was significantly less in all cases compared to the control group. Even for the patients who were lightly anaesthetised, relaxation of muscles in the operative field was quite adequate to facilitate the easy performance of the surgical procedure.
In the cases of MTP and D and C operations, the cervical dilation with a metallic dilator could be achieved very easily in the patients of the first group compared with those of the control group.
After bhramari pranayama, postoperative recovery was smooth. Patients were tension-free and in a relaxed frame of mind.
| Nature of Surgery | With Bhramari Pranayama | Without Bhramari Pranayama |
|---|---|---|
| Tubectomy, MTP, D and C | 6-12 | 18-24 |
| Caesarean Section/Hysterectomy/Others | 12-18 | 24-48 |
Due to the combined effects of the general anaesthesia, anxiety and postoperative sedation, the post-initiation of bowel movement was delayed in the control group. With the study group, bowel movement initiation was much easier and earlier. In the control group, patients experienced a lot of pain and restlessness, postoperatively. In the study group, although some patients experienced pain, it was tolerable and there was not a feeling of restlessness. Most of the patients took only mild pain killers but no sedatives.