Anesthesiology, Critical Care and Pain

The Department of Anaesthesiology aims to provide evidenced-based quality patient care while ensuring patient safety. We are distinctive as one of the few centres in India that exclusively provides anaesthesia for oncological surgery. The wide expanse of our services ensures a continuum of care, throughout the peri-operative period of any patient visiting the hospital. The anaesthesia services have a large footprint in the hospital and currently provide anaesthesia for patients undergoing surgery for neurological, maxillofacial, urologic, orthopaedic, gynaecology, paediatric, breast, abdominal and pelvic malignancies. In addition, we provide services outside the operation theatre which include anaesthesia for diagnostic imaging, interventional radiology, radiotherapy, bone marrow aspiration and diagnostic procedures. The department is well-equipped with state-of-the-art equipment and point of care investigations (TEG, ABG) to ensure optimum care. The department has expertise in use of point-of care ultrasound for diagnostics and regional blocks, videolaryngoscopy, bronchoscopic intubations and cardiac output monitoring. The Pre-Anaesthesia Check-up (PAC) clinic functions daily from 8.30- 17:30, to allow all patients posted for surgeries and procedures under anaesthesia, to be evaluated by the anaesthesiologists. We also run a consultant led high risk joint clinic for evaluation and optimization of patients posted for surgeries.

We provide high quality training to students enrolled for MD Anaesthesia. We also run the Onco-anaesthesia fellowship (accreditated by HBNI). We are also the centre for the FNB Oncoanaesthesia program accreditated by NBEMS. The department provides extensive educational and training opportunities as well as opportunities in clinical audit and research.

At ACTREC, we believe in offering comprehensive, interdisciplinary cancer pain management services, with our aim being facilitating maximum pain control, minimizing treatment-related side effects, and maintaining a patient's optimum wellness. Our services are divided in to acute pain services (APS) and chronic pain services (CP).

APS provides 24/7 care to patients during the perioperative period. We have a treatment plan for each patient that utilizes the latest pain management techniques. We ensure monitoring of patients to maintain comfort levels and reduce side effects and complications. This ensures that postoperative patients can promptly mobilize, engage in physiotherapy, and experience a smoother recovery process.

For CP management, we operate an outpatient department (OPD) at ACTREC, where a meticulous evaluation and assessment of pain are conducted. Each patient receives an individualized pain management plan tailored to their specific needs. As part of our commitment to continuous improvement, we also offer advanced interventional pain procedures. This initiative reflects our ongoing efforts to enhance the overall well-being and quality of life for our patients.

It is a tertiary level cancer critical care unit with 16-bedded intensive care unit (including two isolation beds) plus a 24 bedded Post Anaesthesia Care Unit (PACU) admitting over 700 adult & paediatric patients annually in ICU and 5000 patients in PACU. The ICU team comprises of highly trained and experienced critical care doctors and nursing staff who works round the clock in managing critically ill oncological patients. The ICU and PACU are well equipped with state-of-the-art facilities including but not limited to ventilators, multiparameter monitors, invasive cardiac output monitors, dialysis unit, point of care coagulation testing (TEG), defibrillators, specialized ICU beds for prevention of pressure sore, mechanical devices for prevention of deep vein thrombosis (DVT). ICU has dedicated Point of Care Ultrasound and Echocardiography machine, for bedside decision making and ultrasound-guided procedures. The case mix reflects the complex nature of the oncology patients managed on the unit, admitted following major surgery or for the management of underlying health conditions, cancer or cancer-related treatment. The ICU also leads the CPR team for the hospital. The Intensive care unit runs post-doctoral super speciality intensive care medicine course (DM Critical care medicine ) along with ISCCM diploma and oncocritical care fellowship training accredited by the HBNI university.

Education is a part of the philosophy statement of Tata Memorial Centre. Department of Anesthesiology, Critical Care & Pain stands by this. We are a part of Homi Bhabha National Institute and train students registered for M.D (Anaesthesia), D.M Critical Care) program & Onco-anaesthesia fellowship

We have a total of 90 MD (Anaesthesia) students, 3 Onco-Anaesthesia & Pain fellows, 15 DM critical Care students, 2 IDCCM fellows.

The MD (Anaesthesia) is a 3 year post-graduate program followed by 1 year of bond period. The students rotate through the various operating theatres and peripheral locations like the OPD, Radiology suites (I.R., CT scan, and MRI), Critical Care Unit, and Pain program (Acute & Chronic). This is a residency program, with graded responsibilities in the management and treatment of patients entrusted to his/her care. The participation of the students in all facets of educational process is essential. Every candidate takes part in seminars, grand rounds, case demonstration, journal review meeting and clinical meetings. They have monthly home assignments & a pre-exit & an exit university examination. They have a mentor who guides them through their dissertation.

The DM Critical Care program is also a 3 year course with 1 year of working bond. The students rotate through the Critical Care unit & various other departments like the Microbiology, Radiology, Bone Marrow transplant. IDCCM is a one-year diploma course of Indian Society of Critical Care Medicine (ISCCM).

Conferences/Workshops

The Department runs an annual post-graduate teaching course (Anaesthesia Review Course, “ARC”) since the last 16 years which is attended by students from all over the country. It also holds an annual teaching programme called “THEMATICC” for critical care students & private intensivists since the last 15 years. Since the last 8 years the department organizes a dedicated cancer & acute pain teaching (Education in Cancer & Acute Pain ‘ECAP”) programme for students & private pain physicians. The department also organises an annual national conference “Difficult Airway”, where national and international experts on difficult airway, share their knowledge and experience in the form of didactic lectures, plenary sessions, and debates.

Case based review in Critical care medicine (BRITE) for the students appearing for exit exams of critical care was introduced from last year.

The department has more than 50 clinical studies, which were either completed or ongoing. Project discussion meetings are held at regular intervals where investigators discuss planned projects in the department before submission to the IRB. Members of the Department serve on the Institutional Ethics Committee and the Data and Safety Monitoring Sub-committee.

• Reshma Ambulkar, Aditya Kunte, Akansha Sarangi, Sudhir Nair, Tihitena Negussie,Isabela Lima, Mansi Tara.Long-term sustainability of peri-operative infection control practices: Implementation of “Clean Cut”, a checklist-based quality improvement program in India.& quot; Accepted by Surgical Infections journal on 1.04.24.


• Ambulkar R, Moharana SK, Solanki SL, Salunke BG, Agarwal V. Acute postoperative pain management techniques, their efficacy and complications after major gastrointestinal and hepato-pancreato-biliary cancer surgeries: An observational study. J Perioper Pract. 2024 Feb 12:17504589231224563


• M Nofal et al. Reshma ambulkar Clean Cut Investigators Group. An observational cohort study on the effects of extended postoperative antibiotic prophylaxis on surgical-site infections in low- and middle-income countries. Br J Surg. 2024 Jan 3;111(1)


• Reshma Ambulkar, Supriya Gholap, Bindiya Salunke, Sumitra Bakshi. Audit of Pain Management After Colorectal Surgeries in a Tertiary Care Cancer Hospital. Indian Journal of Surgical Oncology.


• Ambulkar Reshma; Baskar Vignesh; Patkar, Shraddha; Kunte, Aditya; Agarwal, Vandana; Solanki, Sohan Lal; Divatia, Jigeeshu V. Evaluation of perioperative routine coagulation testing versus thromboelastography for major liver resection – A single-arm, prospective, interventional trial (PORTAL trial). Indian Journal of Anaesthesia 67(12):p 1077-1083, December 2023.


• Patil SJ,Ambulkar R, Kulkarni AP. Patient Safety in Intensive Care Unit: What can We do Better? Indian J Crit Care Med 2023;27(3):163–165.


• Ambulkar R, Parab SY, Vignesh B, Nagargoje V, Janu A, Parikh P, Moiyadi A. A prospective study to evaluate the use of surveillance venous ultrasonography to detect incidence of deep venous thrombosis following neurosurgical excision of brain tumors. J Neurosci Rural Pract. 2023 Apr-Jun;14(2):252-257.


• Thomas M, Agarwal V, DeSouza A, Joshi R, Mali M, Panhale K, Salvi OK, Ambulkar R, Shrikhande S, Saklani A. Enhanced recovery pathway in open and minimally invasive colorectal cancer surgery: a prospective study on feasibility, compliance, and outcomes in a high-volume resource limited tertiary cancer center. Langenbecks Arch Surg. 2023 Feb 22;408(1):99


• Sohan Lal Solanki, Bindiya Salunke, Gauri Gangakhedkar, Reshma Ambulkar, Deepali V. Kuberkar, Aditi Bhatt, Acute Kidney Injury after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy- A Systematic Review, European Journal of Surgical Oncology,2024,108622,ISSN 0748-7983,


• Kothekar AT, Wajekar AS, Joshi AV. Videolaryngoscopy: Channelizing through Intensive Care Unit Intubations. Indian J Crit Care Med. 2023 Feb;27(2):85-86.


• Kothekar AT, Mohanty R, Joshi AV. Goal-directed Fluid Therapy in Neurosurgery: Three Feet from Gold? Indian J Crit Care Med. 2023 Oct;27(10):697-698. doi: 10.5005/jp-journals-10071-24557. PMID: 37908432; PMCID: PMC10613869.


• Wajekar A, Solanki S.L, Cata J, Gottumukkala V. Postoperative Complications Result in Poor Oncological Outcomes: What Is the Evidence? Curr. Oncol. 2024, 31, 4632–4655.


• Thota RS, Ramkiran S, Singh S, Damani A, Wajekar AS, Koyyalagunta L. A systematic review and quality analysis of cancer pain guidelines. Indian J Anaesth. 2023 Dec;67(12):1051-1060.


• Ranganathan P, Salunke B, Wajekar A, Siddique A, Daruwalla K, Chawathey S, Niyogi D, Nayak P, Divatia J. Outcomes of elective cancer surgery in COVID-19 survivors: An observational study. J Surg Oncol. 2023 Jan;127(1):11-17.


• Gupta, Mahima; Bakshi, Sumitra G.1; Rane, Ashwini D.2; Shrivastava, Anjana1; Patole, Monali R.3; Gaikwad, Sheetal V.1; Salunke, Bindiya G.1. Residents’ Perspective of the WhatsApp and Videoconference-based Educational Programme: A Cross-sectional Study. Journal of Onco-Anaesthesiology and Perioperative Medicine 1(2):p 75-79, May–Aug 2024. | DOI: 10.4103/JOAPM.JOAPM_6_24


• Gangakhedkar GR, Monteiro JN, Bedekar U, Desai M. A national online questionnaire- based survey, regarding the awareness and implementation of enhanced recovery after surgery practices in neurosurgical procedures. Indian J Anaesth. 2023 Feb;67(Suppl1):S60-S63.


• Goyal, Vipin Kumar*; Mandal, Sony1; Nimje, Ganesh Ramaji; Shekhrajka, Praveenkumar2; Rana, Pankaj Singh; Mittal, Saurabh. Acute Pain Management after Kidney Transplantation: A Current Review of Literature. Indian Journal of Transplantation 17(4):p 402-409, Oct–Dec 2023. | DOI: 10.4103/ijot.ijot_49_23


• Pankaj Singh Assessment of fluid responsiveness after tidal volume challenge in renal transplant recipients: a non-randomized prospective interventional study.


• Sanapala V, Patil V. Revamping Communication Strategies: Emphasizing Emotional Connect in Times of Crisis. Indian J Crit Care Med. 2023 Aug;27(8):529-530. doi: 10.5005/jp-journals-10071-24515. PMID: 37636854; PMCID: PMC10452771