Interrelationship of Deha Prakriti, Manas Prakriti, and Stress Physiology in Isoflurane-Based General Anesthesia: A Review

Background: Individual variability in responses to anesthesia continues to pose a considerable challenge in the domain of perioperative medicine. Pharmacogenomics has improved our understanding of the natural differences in how drugs are broken down, but ayurveda, an ancient indian system of medicine, already knew about this psychophysical variability through the ideas of deha prakriti (physical constitution based on the vata, pitta, and kapha doshas) and manas prakriti (mental constitution based on the sattva, rajas, and tamas gunas). Contemporary research has commenced the validation of these psycho-physical classifications at genomic and biochemical levels, indicating their potential relevance in the field of anesthesia. Objective: The objective of this integrative review is to explore the interrelationships among deha prakriti, manas prakriti, and the physiology of perioperative stress in the context of isoflurane-based general anesthesia, and to propose a conceptual framework for personalized anesthesia based on ayurvedic physiological assessment. Methods: Research was conducted using the pubmed, google scholar, scopus and web of science databases through a full literature search with keywords including prakriti, manas prakriti, stress physiology, isoflurane, general anaesthesia, hpa axis, personalised anaesthesia. Ancient ayurvedic texts such as charaka samhita, sushruta samhita, and ashtanga hridaya were reviewed in addition; peer-reviewed papers, experimental works, and clinical trials published until 2025 were included. Discussion: Research indicates that there is a relationship between deha prakriti and certain metabolic, cardiovascular, and autonomic characteristics that can impact the way drugs are processed by the body, how the body reacts to drugs, and also what dose of a drug would provide a person with an effective dose of that drug (minimum alveolar concentration). Additionally, manas prakriti has an effect on preoperative anxiety and perceived level of stress, which also influences the person's sympathetic nervous system activation level and their pain sensitivity. Together these two types of prakriti create a perioperative state of stress physiology governed by the Hypothalamic-Pituitary-Adrenal Axis and alter the actions of anesthesia. Conclusion: Evaluating the prakriti (constitution) of the deha (body) and manas (mind) as part of a perioperative assessment can help develop highly tailored anaesthetic protocols and thereby support prevention of hemodynamic instability, optimising anaesthetic doses, and improving recovery after surgery.