Context: Preoperative anxiety is considered real concern for many patients undergoing anesthesia and surgery that may cause tachycardia, hypertension and arrhythmias. Study aim: To evaluate effectiveness of alternate nostril breathing exercise on preoperative patients' anxiety, blood pressure and heart beats. The study used a quasi-experimental design, specifically employing a pre/post-test on purposive sample of 100 adult preoperative patients' who divided equally into study and control group in accordance to inclusion and exclusion criteria. Setting: conducting of this study was in general surgery units at Benha University Hospital, Qualyubia Governorate, Egypt. Three tools were utilized in this study: I: Patient' Structured interview questionnaire, II: Beck Anxiety Inventory Scale, III: Physiological parameters assessment. Results: Indicated a statistically significant improvement in total mean score of patients' anxiety, systolic blood pressure, diastolic blood pressure and heart beats after exercise implementation (P<0.001) as, the total mean score of patients' anxiety, systolic blood pressure, diastolic blood pressure and heart beats for study group were (134.80±6.14, 84.10±5.41 and 95.06±8.10 respectively) pre-exercise and declined post exercise into (116.40±4.84, 77.20±4.53and 78.90±6.94 respectively). Conclusion: Alternate nostril breathing exercise seemed to have a positive impact on preoperative patients' anxiety, blood pressure and heart beats. Recommendations: Further research studies should be done on a large probability sample from different geographical areas is needed.