'FIKA BREAKS' IN THE NEUROANESTHESIA: ENHANCING WELL-BEING AND PERFORMANCE- A NARRATIVE REVIEW.

American Journal of Sustainable Cities and Society Issue 15, Vol. 2, 2025 Available online on http://www.rspublication.com/ajscs/ajsas.html ISSN 2319 – 7277 DOI: 10.5281/zenodo.17295054 Original Article ©2025 RS Publicaon, rspublica[email protected] 639 ‘FIKA BREAKS’ IN THE NEUROANESTHESIA: ENHANCING WELL-BEING AND PERFORMANCEA NARRATIVE REVIEW. Dr. Madhusudhana Rao. B 1 ; MD; PDCC; DNB; MNAMS; DM (Neuroanesthesia), Dr. Seham Syeda 2 ; MD, DNB, DM, DESIAC 1.Assistant Professor, Department of Anesthesia, Division of Neuroanesthesia and Neurocritical Care; Ramaiah Memorial Hospital, Ramaiah Medical College, Banguluru, Karnataka, India. 2. Assistant Professor, Department of Anesthesia, Division of Neuroanesthesia and Neurocritical Care; Ramaiah Memorial Hospital, Ramaiah Medical College, Banguluru, Karnataka, India. ARTICLE INFO Abstract ©2025 RS Publication Paper ID: AJSCS68E4B66CACC59 Received: 2025-09-08 Published: 2025-10-08 DOI: https://dx.doi.or g/10.5281/zenodo. 17295054 Page No: 639-649 Neuroanesthesia, which involves high-risk neurosurgery, requires constant attention, mental clarity, and emotional strength. This leads to significant rates of burnout (50–70%) and fatigue-related dangers among staff. The Swedish fika break, a planned 15–30-minute respite for coffee, tea, snacks, and social engagement, corresponds with evidence-based fatigue management measures, while not specifically identified in neuroanesthesia research. Fika, based on research in anesthesiology and emergency medicine, lowers cognitive fatigue (for example, it raises Karolinska Sleepiness Scale scores from 5.5 to 4.6), helps prevent burnout by providing peer support, eases musculoskeletal strain, and improves team cohesion, which is important for communication in the operating room. Two daily fika breaks are possible between cases, using hospital break rooms and snacks that are appropriate for the culture. Although research specifically focused on neuroanesthesia is necessary, fika's affordability and flexibility make it a vital intervention for promoting staff well-being, minimizing errors, and improving patient safety in this demanding sector. Keywords: Fika breaks, Neuroanesthesia, Fatigue management, Burnout prevention, Cognitive alertness. Corresponding Author: Dr. Madhusudhana Rao. B Mail:  drmadhusudha[email protected] American Journal of Sustainable Cies and Society Available online on h!p://www.rspublicaon.com/ajscs/ajsas.html ISSN 2319 – 7277 CODEN(USA): Ajscs0] Cite This Paper: Dr.Madhusudhana Rao.B and Dr. Seham Syeda(2025). "‘FIKA BREAKS’ IN THE NEUROANESTHESIA: ENHANCING WELL-BEING AND PERFORMANCEA NARRATIVE REVIEW.". AMERICAN JOURNAL OF SUSTAINABLE CITY AND SOCIETY (AJSCS), vol. 15, no. 5, 2025, pp. 639-649. DOI: h>ps://dx.doi.org/10.5281/zenodo.17295054 American Journal of Sustainable Cities and Society Issue 15, Vol. 2, 2025 Available online on http://www.rspublication.com/ajscs/ajsas.html ISSN 2319 – 7277 DOI: 10.5281/zenodo.17295054 Original Article ©2025 RS Publicaon, rspublica[email protected] 640 Introduction: Fika is a beloved Swedish cultural ritual that is more than just a coffee break. It sounds like "feeka," and it can be a noun (the break itself) or a verb (to "fika" means to take such a break). Fika is a break in the middle of the day to enjoy a hot drink, usually coffee, although tea or juice can do. You also get a tiny sweet treat, like cinnamon buns (kanelbullar), pastries, biscuits, or even openfaced sandwiches. But the real meaning of fika is its social and thoughtful parts. It's a planned ritual to slow down, go away from work or computers, and talk to other people in a calm way, without any agendas or work-related stress. Fika is a big part of everyday life in Sweden. It's usually planned twice a day at work (about 10:00 a.m. and 3:00 p.m.) and lasts 10 to 30 minutes. It's thought to be important for community and well-being. Even big corporations like Volvo and Vattenfall use it, and some even have special areas and free drinks. It's okay to have a solo fika to think about things, but most people do it with coworkers, friends, or family to strengthen their relationships. [1-10] Advantages of the Fika Break Adding fika to your daily routine has many proven benefits, which is why Sweden is known as one of the happiest and most productive countries in the world (even if people don't work much overtime). Some of the main benefits are: [11-16] Stress Reduction and Mental Health: Fika gives you an organized break from your everyday tasks, which helps lower cortisol levels and keep you from being burned out. Studies demonstrate that it helps people relax and feel better when they are under a lot of stress, as at medical conferences. It's a thoughtful retreat that helps you enjoy the moment, which makes you happier with your life as a whole. More productivity and alertness: Fika doesn't waste time; it recharges the brain, making it easier to focus and get things done when you get back to work. The Karolinska Sleepiness Scale showed that people who took fika breaks felt less sleepy (from 5.5 to 4.6 on average), which made the learning or working environment more awake. Swedes' minimal overtime and high output (according to OECD data) are largely due to these kinds of rituals. Fika breaks down hierarchies and encourages casual conversations that establish trust and friendship. This makes people feel more connected to each other and helps them work together better. This makes it easier for people to share information, work together, and have a good working culture, which is very important in Sweden, where decisions are made by agreement. It helps people get to know each other better, which makes them feel less alone and happier at work. Better health and energy: Caffeine, light snacks, and activity (like getting together in a break room) keep energy levels up without making you crash. It encourages drinking enough water and eating a balanced diet, and the social aspect can motivate people to live better lives in general. Fika turns regular breaks into chances to relax and recharge, making it a simple yet powerful way to improve your personal and professional life. [3-9] American Journal of Sustainable Cities and Society Issue 15, Vol. 2, 2025 Available online on http://www.rspublication.com/ajscs/ajsas.html ISSN 2319 – 7277 DOI: 10.5281/zenodo.17295054 Original Article ©2025 RS Publicaon, rspublica[email protected] 641 “Burnout syndrome” in anesthesiologists [17-22] Burnout is a work-related condition that happens when stress at work builds up over time and is not handled well. It has three parts: (1) sensations of being drained or exhausted; (2) a greater mental detachment from one's employment, negativity or cynicism toward work; and (3) a lower level of professional effectiveness. Why anaesthesiologists are in danger Anesthesiology includes high-stakes, high-responsibility work, long and unpredictable hours, exposure to important occurrences, and the need to make quick decisions often. These things all raise the risk of chronic occupational stress and burnout. Big surveys have indicated that a lot of anesthesiologists are at high risk of burnout. For example, a big US poll found that about 59% were at high risk and about 13.8% met the criterion for burnout. Common characteristics or clinical presentation: Emotional exhaustion: always feeling exhausted and having less energy to work. Cynicism and depersonalization: keeping a distance from patients and coworkers and having unfavorable attitudes. Less effective at work: feeling incompetent, less satisfied with the job, and doing worse. These are in line with the WHO/ICD-11 and the Maslach conceptualization. Common risk factors in anesthesiology System/organizational: too much work, not enough staff, too much paperwork, not enough help at work, and lengthy or night shifts. Specialty-related: being around life-threatening events often, feeling bad about things that go wrong, and not knowing what will happen next. Individual: not enough time to recover, not enough balance between job and home life, and being vulnerable (for example, having mental health problems before). Consequences For doctors: more anxiety and despair, trouble sleeping, a higher risk of substance abuse, worse health, and in some reports, more thoughts of suicide. For patients and systems: a greater chance of medical mistakes, less effective teamwork, more staff turnover, and staffing issues. American Journal of Sustainable Cities and Society Issue 15, Vol. 2, 2025 Available online on http://www.rspublication.com/ajscs/ajsas.html ISSN 2319 – 7277 DOI: 10.5281/zenodo.17295054 Original Article ©2025 RS Publicaon, rspublica[email protected] 642 Evaluation / quantification The Maslach Burnout Inventory (MBI) is the most popular tool for measuring emotional tiredness, depersonalization, and a lack of personal achievement. Shortened or abbreviated variants exist, although they can exaggerate prevalence in some groups (this is an essential methodological factor to keep in mind when reporting prevalence estimates). When reporting prevalence, use proven tools and set cut-offs. Remedial measures — approaches based on evidence At the level of the organization (most impact):Make personnel and workload distribution better, restrict hours that are too long, give protected breaks, and make schedules that are easy to understand. Strengthen collegial assistance (peer support, talking about what happened after a catastrophic incident), train leaders, and cut down on superfluous administrative work. Make mental health services easy to go to and offer private help. At the level of the individual (complementary): Encourage strategies that help people be strong and get better, like getting enough sleep, exercising, getting social support, practicing mindfulness other short stress-relief techniques, and getting professional treatment when needed. Individual treatments help, but they don't work as well on their own as improvements to the organization. [17-22] Why Anesthesia Staff Need Fika Breaks [23-31] 1. Lessening of Stress and Burnout: Anesthesia entails persistent stressors such unexpected schedules, crises during surgery, and moral issues, all of which can lead to burnout syndrome, which is marked by emotional weariness and depersonalization. Fika's mindful pause and social support lower cortisol levels, which helps people relax and avoid burnout. This is similar to how coffee breaks in healthcare improve team morale and wellness on the job. This break is very important for anesthesia staff to take throughout lengthy shifts (12 to 24 hours) to recharge. It cuts down on absences and makes people happier at work. 2. Better Alertness and Cognitive Performance: In anesthesia, it is very important to be vigilant in order to keep an eye on vital signs and respond to emergencies, when being tired can lead to mistakes. Fika, which is a combination of caffeine and a short nap, might make you less sleepy (for example, it went from 5.5 to 4.6 on the Karolinska Sleepiness Scale in a study of a medical conference), which helps you stay focused and engaged. Anesthesia workers require this to keep things accurate throughout procedures. Nudge-based breaks have been demonstrated to improve intraoperative practices without getting in the way of workflow. American Journal of Sustainable Cities and Society Issue 15, Vol. 2, 2025 Available online on http://www.rspublication.com/ajscs/ajsas.html ISSN 2319 – 7277 DOI: 10.5281/zenodo.17295054 Original Article ©2025 RS Publicaon, rspublica[email protected] 643 3. Better communication and teamwork: Anesthesia teams work closely with surgeons, nurses, and technicians in operating rooms, where mistakes in communication can put patients at risk. Fika's non-hierarchical social aspect develops trust and encourages casual conversations, which improves team culture and relationships, as shown in general workplace fika research. It is very important for anesthetic personnel to talk about cases after they happen. This helps them feel less alone and encourages them to work together with people from other fields. 4. Lessening of Physical and Emotional Stress: Standing for a long time, being in uncomfortable positions, and dealing with the emotional toll of high-risk situations make musculoskeletal problems and stress worse in anesthesia. Fika promotes movement and peer support, offering a reset that enhances mindfulness and energy, akin to how coffee breaks aid relaxation and productivity in high-pressure positions. This helps anesthesia workers keep up their performance and emotional strength, especially during long surgeries. Practical Implementation for Anesthesia Staff Frequency and Duration: Two 15–30-minute fika breaks every day (for example, in the middle of the morning and in the middle of the afternoon) fit between cases or during quieter times, using hospital break spaces with tea/coffee and snacks. Adaptation: Include local favorites (such tea or energy snacks) and switch workers around to make sure there is always coverage, since short breaks keep staff energized without affecting patient care. Challenges: Time limits in ORs may make it harder to adopt, but evidence-based nudges can encourage breaks without costing more. To sum up, fika breaks are helpful for anesthetic staff because they help with burnout, make people more alert, and improve teamwork in a job that is quite demanding. There is not enough direct research on anesthesia, but research from other domains shows that it is useful, thus pilot initiatives should be started in anesthesiology departments. [23-31] Supportive Literature on Fika Breaks in Neuroanesthesia Fatigue Management Strategies The Swedish fika break, a scheduled intermission for coffee or tea, snacks, and social engagement, is rarely explicitly referenced in neuroanesthesia fatigue management literature owing to its cultural distinctiveness and restricted use beyond Sweden. However, supportive literature from anesthesiology, neuroanesthesia, and allied healthcare sectors indicates that fika closely corresponds with evidence-based tiredness management measures, including strategic breaks, caffeine utilization, and team-based interventions. These tactics are essential for neuroanesthesia personnel, who encounter significant cognitive demands, extended periods of attention (e.g., during 6–12-hour neurosurgeries), and elevated burnout rates (50–70%). I summarize the relevant evidence below that supports the idea that fika could be used to help control fatigue in neuroanesthesia. I focus on studies that look at breaks, coffee, and social support. American Journal of Sustainable Cities and Society Issue 15, Vol. 2, 2025 Available online on http://www.rspublication.com/ajscs/ajsas.html ISSN 2319 – 7277 DOI: 10.5281/zenodo.17295054 Original Article ©2025 RS Publicaon, rspublica[email protected] 644 Supportive Literature and Alignment with Fika [9,12,23,32-40] 1. Fatigue in Anesthesia: Consequences and Approaches for Patient and Provider Safety (Howard et al., 2002) Important Results: This review stresses the importance of taking breaks on a regular basis as a key way to manage fatigue in anesthesiology. This helps keep patients safe and reduces cognitive overload. Taking breaks of 15 to 30 minutes, which is about the same length as a fika, might help lessen the consequences of being alert for a long time, which is very important in neuroanesthesia for keeping an eye on cerebral perfusion and intracranial pressure. Relevance to Fika: Fika's organized break directly supports this method by providing a realistic way to take breaks in neuroanesthesia situations, such as between cases or during non-critical periods. The social aspect makes it easier to relax, which lowers the number of mistakes made while you're tired even more. 2. What the Fika? Execution of Swedish Coffee Breaks at the Emergency Medicine Conference (Kellar et al., 2024) Key Findings: This multicenter study employed the Karolinska drowsiness Scale (KSS) to evaluate the effects of fika on emergency medicine residents, revealing a notable decrease in drowsiness scores (from 5.5 to 4.6, P=0.004) during 15-minute fika breaks that included coffee and social interaction. The study emphasizes fika's contribution to enhancing alertness and engagement, particularly in high-cognitive-load environments such as neuroanesthesia. Relevance to Fika: Neuroanesthesia necessitates comparable prolonged focus (e.g., observing neurological alterations). Fika's caffeine and rest elements correspond with established fatigue mitigation strategies, such as tactical caffeine consumption, to augment alertness. 3. Using the Nudge Theory to Improve Breaks for Attending Anesthesiologists (Smith et al., 2024) Key Findings: This study evaluated nudge-based interventions (e.g., reminders, scheduled breaks) to enhance break-taking among anesthesiologists, thereby enhancing intraoperative performance without disturbing workflows. Short breaks of 10 to 20 minutes were helpful in lowering tiredness and improving focus. Relevance to Fika: The planned and scheduled aspect of Fika is similar to these nudge treatments, which makes it possible for neuroanesthesia professionals to include pauses during long surgeries to keep performance up and keep patients safe. 4. Burnout and Wellness: The Anesthesiologist’s Perspective (Aibekov et al., 2021) Key Findings: This analysis indicates burnout as a significant concern in anesthesiology (50–70% prevalence), particularly intensified in subspecialties such as neuroanesthesia due to emotional and American Journal of Sustainable Cities and Society Issue 15, Vol. 2, 2025 Available online on http://www.rspublication.com/ajscs/ajsas.html ISSN 2319 – 7277 DOI: 10.5281/zenodo.17295054 Original Article ©2025 RS Publicaon, rspublica[email protected] 645 cognitive demands. To reduce burnout and boost resilience, it is suggested that people get help from friends and family and that workplaces offer breaks and other interventions. Relevance to Fika: Fika's social interaction encourages peer support, which directly addresses emotional tiredness in neuroanesthesia, where professionals deal with high-stakes situations (such brain tumor procedures). Its contribution to team cohesion corresponds with suggested wellness approaches. 5. The Impact of Intraoperative Reading on Vigilance and Workload in Anesthesia Care (Slagle & Weinger, 2009) Key Findings: This study determined that short diversions (e.g., non-work activities during lowworkload periods) do not diminish attentiveness and may alleviate fatigue in anesthesiologists. It was advised that structured breaks be used to keep performance up throughout protracted instances. Relevance to Fika: Fika's short, agenda-free social break is a helpful distraction that helps keep people alert during neuroanesthesia by letting them reset their minds without missing anything important. 6. A Review of Caffeine in Anesthesia (McCartney et al., 2013) Important Results: Caffeine is a proven way to fight fatigue in anesthesiology. When used in moderation (like coffee throughout breaks), it makes you more awake without causing many problems. Taking 100 to 200 milligrams, which is common in fika, can help your brain work better. Relevance to Fika: The coffee/tea part of Fika directly supports this technique by giving people a practical means to get caffeine during neuroanesthesia shifts, which helps them focus on important tasks like treating cerebral ischemia. Conclusion: Fika breaks, a Swedish custom involving 15–30-minute intervals for coffee or tea, snacks, and social engagement, provide a pertinent yet under-researched fatigue management approach in neuroanesthesia. Because this sector requires a lot of mental focus, long procedures, and has burnout rates of 50–70%, it needs effective therapies. Research from anesthesiology and emergency medicine indicates that fika diminishes cognitive weariness, promotes alertness (e.g., a reduction in the Karolinska Sleepiness Scale score from 5.5 to 4.6), alleviates burnout through social support, decreases physical strain, and improves team communication, which is essential for patient safety. In high-pressure neuroanesthesia settings, it is possible to take two daily fika breaks, with local refreshments and timed between cases. While direct studies are absent, fika's correlation with established tactics such as breaks and coffee consumption underscores its American Journal of Sustainable Cities and Society Issue 15, Vol. 2, 2025 Available online on http://www.rspublication.com/ajscs/ajsas.html ISSN 2319 – 7277 DOI: 10.5281/zenodo.17295054 Original Article ©2025 RS Publicaon, rspublica[email protected] 646 importance as a cost-effective means to enhance staff resilience and performance, necessitating additional research. References: 1. 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