What to Expect as a Patient

Anesthesiology is just one aspect of your medical procedure – but it’s very important for your comfort and safety. With Great Lakes, our experienced team is here to guide you through the entire process – from providing easy-to-follow pre-surgery instructions to making sure you recover properly.

Below, you’ll find patient information and resources. If you have any additional questions, please don’t hesitate to contact us.

Insurance we accept

As of January 1, 2022, Great Lakes Anesthesiology is happy to accept health insurance plans from the following providers.

Aetna Health

AmeriHealth Health Plan

AmeriGroup

Excellus

Highmark of Western New York (formerly BlueCross BlueShield of WNY)

Highmark of Pennsylvania

Independent Health

Univera Health Care

WellCare

New York Medicaid

Pennsylvania Medicaid

Worker’s Compensation and No-Fault

Medicare

Nova

Fidelis

Tricare

Coventry

The Empire Plan

Meritain Health​

Where we practice.

Great Lakes manages the anesthesia department at several healthcare facilities in Western New York and northern Pennsylvania. Visit our Locations page for information and directions.

Frequently asked questions.

What food and drink should I avoid before my surgery?

NPO stands for Nil Per Os, which is Latin for ‘Nothing By Mouth.’ Fasting before elective surgery is essential for your safety. Under general anesthesia, your body loses the protective reflexes that prevent your stomach contents from being breathed into your lungs. This is called aspiration, which can be life-threatening.

An empty stomach is the best way to prevent aspiration. If you eat food or drink beverages before your surgery, the procedure will be delayed or canceled in order to protect you.

Click here to read our policy.

What medications should I take before the surgery?

Your surgeon or anesthesiologist will give you specific instructions on what medications to take and what should be stopped. You may take most medications with a small sip of water before surgery.

Common drugs that should be taken on the day of surgery include:

  • Beta-blockers (Inderal, atenolol, propranolol, etc.)
  • Thyroid medications (levothyroxine)
  • Seizure medications (Dilantin, valproic acid, Tegretol, Topamax, etc.)
  • Asthma medications, including inhalers (albuterol, etc.)

Drugs that should be stopped before the day of surgery include:

  • Blood thinners (aspirin, heparin, Lovenox, Warfarin, coumadin, etc.)
  • ACE inhibitors for hypertension (Captopril, Enalapril, Losartan, etc.)

Some children can only take their medication with food. In that case, please contact our office for specific instructions before the day of surgery. Taking medication with food on the morning of surgery might cause the procedure to be delayed or canceled.

If you have any questions about drugs you should take before your surgery, please contact your surgeon or your anesthesia team at our office.

What is an anesthesiologist, and what training do they go through?

Your anesthesiologist is a doctor. After medical school, they completed a one-year internship and a residency of at least three more years in the specialty of anesthesia. In addition, they may have done even more specialized training in pediatric anesthesia, pain medicine, cardiac anesthesia, or other subspecialties. In total, your anesthesiologist has spent more than eight years since starting medical school preparing for your operation, in addition to many years of experience.

Who will be watching over me during my operation?

Our anesthesiologists most often practice in the Anesthesia Care Team model. The team includes anesthesia residents (doctors in anesthesia training) and fellows (anesthesia doctors who are obtaining advanced subspecialty training) as well as skilled certified registered nurse anesthetists (CRNAs). In order to provide safe patient care, the anesthesiologist directs the Anesthesia Care Team. The anesthesiologist is responsible for evaluating the patient before surgery, prescribing the anesthetic plan, managing the anesthetic during surgery, and providing post-anesthesia care.

What If I have questions before my procedure?

You will meet your anesthesia team on the day of surgery. We will ask you many questions about your health and anesthesia experiences to plan the best anesthetic for you. For most patients, all of their concerns are addressed at that time. Some patients have special medical issues and may be referred by their surgeon to our office for a preoperative consultation. Many patients will also be sent to their primary care doctor to get a complete and up-to-date picture of their health problems. If you have specific questions or concerns, we would happily speak with you by telephone. Usually, that will save you a special trip to our office.

What if I get a surprise or out-of-network balance bill after my surgery?

When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing, also called surprise billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance, or deductible.

You’re never required to give up your protection from balance billing. Generally, your health plan must:

  • Cover emergency services without requiring you to get approval for services in advance (also known as “prior authorization”)
  • Cover emergency services by out-of-network providers
  • Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility, and show that amount in your explanation of benefits
  • Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit

If you think you’ve been wrongly billed, contact, please call 1-800-985-3059.

What should I know about my GLP-1 medications if I am preparing to have surgery or undergo anesthesia?

There are several considerations individuals taking GLP-1 medications should consider before surgery:

GLP-1 Agonists: These are medications used primarily for diabetes and weight loss. They work by increasing a hormone called GLP-1 in the body, which helps control blood sugar levels and can lead to weight loss.

Concerns for Anesthesia: Anesthesiologists are worried about these medications because they can slow down the emptying of the stomach. This means that during surgery, there’s a higher risk of food or liquid from the stomach coming up and getting into the lungs, which can be dangerous.

Recommendations for Surgery: If you’re taking GLP-1 agonists and need surgery, the American Society of Anesthesiologists suggests skipping one dose of the medication before the procedure. However, this alone might not be enough to reduce the risk, so other precautions might be needed.

Gastric Ultrasound: Before surgery, a special ultrasound of the stomach can help doctors see if there’s any food or liquid present, which can help them plan the surgery more safely.

Airway Protection: For surgeries that require deep sedation or general anesthesia, it’s recommended to use a method called rapid sequence induction to secure the airway and reduce the risk of complications.

Timing of Surgery: If possible, it might be safer to delay elective surgery until you’ve been on the GLP-1 medication for more than 3 months, as the risk of delayed stomach emptying decreases over time.

If you’re taking GLP-1 agonists for diabetes or weight loss, it’s important to communicate this to your healthcare team before any surgery, as special precautions may be needed to ensure your safety. Read more from GLA’s Dr. Jerrold Lerman here.

What are the post-pandemic COVID-19 guidelines for pediatric surgical patients?

Current evidence indicates that the morbidity from COVID-19 in 2022/23 has diminished with fewer hospital admissions, fewer ICU admissions, and a reduced mortality rate compared with the first wave of COVID-19. Given this trend and the fact that COVID-19 is primarily a virus infecting the respiratory system, the American Society of Anesthesiologists, the Anesthesia Patient Safety Foundations, the Royal Australasian College of Surgeons, the Australia and New Zealand College of Anaesthetists, the Royal College of Surgeons of England, and the Royal College of Anaesthetists have recommended the following guidelines for children with a COVID-19 positive test result:

With a positive test for COVID-19 and mild or no symptoms, elective surgery should be deferred for 2 weeks. If the surgery or patient’s comorbidities increase the risk if the surgery were delayed, then consideration should be given to proceeding and informing the parents of the increased risks.

With a positive test for COVID-19 and moderate to severe symptoms or ongoing COVID-19 symptoms, elective surgery should be delayed for 7 weeks or more, although one study recommended a 4-week delay with no further benefits accrued from delays beyond 4 weeks.

Children with ongoing respiratory symptoms and a high fever preoperatively are at greater risk for oxygen desaturation in PACU and as such surgery should be delayed to mitigate those risks.

If the delay increases either the risks to the child and/or compromises the surgery, consideration should be given to proceeding after the surgeon, anesthesiology provider and parents discussed the risk/benefits of proceeding.

The definitions for the clinical severity of COVID-19 are*:

  • Asymptomatic: PosiMve SARS-CoV-2 test with no symptoms
  • Mild: Slight COVID-19 symptoms without shortness of breath
  • Moderate: Evidence of lower respiratory disease (e.g. shortness of breath) during clinical or imaging assessment; peripheral blood oxygen saturation (SpO2) ≥94% on room air
  • Severe: Signs and symptoms of severe lower respiratory disease necessitating hospitalization; usually oxygen therapy and SpO2 ≤94% on room air
  • Long COVID: Signs and symptoms that:
    • Continue or develop usually 3 months from the onset of COVID-19 infection
    • Lasts >2 months
    • Cannot be explained by an alternative diagnosis

*NSW Agency for Clinical InnovaMon. Timing of surgery after COVID-19 in adults. Sydney: ACI; 2023

Read more about COVID-19 considerations for pediatric surgical patients from GLA’s Dr.  Jerrold Lerman here.

“Our family is forever grateful for the knowledgeable and compassionate team at Great Lakes Anesthesia. Having experienced a complicated and painful pregnancy, they provided the first true moment of relief and ease.”

Courtney, patient

Billing information.

Anesthesia services are billed separately from surgery and hospital charges. The estimated amount of your bill for anesthesia services is available upon request by contacting our office.

Actual anesthesia charges may exceed the estimated bill for many reasons, such as surgery taking longer than expected, the surgery ending up more extensive than initially planned, or the need for treatments that were not anticipated. We strongly encourage you to contact our office before elective surgery to discuss the billing process, patient responsibility, and situations with non-participating or out-of-network insurance.

If you have questions or concerns about a bill, please call the Great Lakes Anesthesiology billing office at (716) 323-6580. We are available Monday through Friday, 8:00 a.m to 4:00 p.m.

Have a question?

To learn more about what Great Lakes has to offer, fill out the short form below or call our administrative office at 716.323.6570. We look forward to talking with you.

Jerrold Lerman, BASc, MD, FRCPC, FANZCA

Jerrold Lerman, BASc, MD, FRCPC, FANZCA

Vice President|Site Director, Buffalo Ambulatory Surgery Center (BASC)|Co-Site Director, Warren General Hospital

Dr. Jerrold Lerman is Vice President of the board of directors at Great Lakes Anesthesiology. He is also the Site Director, Buffalo Ambulatory Surgery Center (BASC) and Co-Site Director, Warren General Hospital.

Dr. Lerman has over 40 years of clinical experience and is board certified in the United States and Canada. He earned a B.S. in chemical engineering from the University of Waterloo before attending medical school at the University at Toronto in Ontario, Canada. He completed his internship at Toronto General Hospital and residency at the University at Toronto.

His areas of interest include pediatric Anesthesia and research. He serves as the Clinical Professor of Anesthesiology at Jacob's School of Medicine and Biomedical Sciences in Buffalo, NY. Dr. Lerman is affiliated with the Royal College of Physicians and Surgeons of Canada and is a Fellow of the Australia and New Zealand College of Anaesthetists (ANZCA). He is also a member of the American Society of Anesthesiologists; Society of Pediatric Anesthesia; AUA; New York State Society of Anesthesiologists; APA; FEAPA;

Dr. Lerman has been a member of Great Lakes Anesthesiology since 2002 and views the company as "a wonderful family that supports each other both at work and outside of work."

Navyugjit S. Virk, MD

Navyugjit S. Virk, MD

President, Operating Room Coordinator, Oishei Children’s Hospital, Buffalo NY & Co-Site Director, Warren General Hospital

Dr. Virk is the President and CEO of Great Lakes Anesthesiology, as well as the OR Coordinator at Oishei Children’s Hospital, and Co-Site Director at Warren General Hospital in Warren, PA. He is certified by the American Board of Anesthesiology and specializes in obstetric anesthesia and pediatric anesthesia, in which he is Fellowship trained.

After completing his undergraduate studies at SUNY University at Buffalo, Dr. Virk graduated from medical school at the University of Silesia in Poland. He returned to Western New York for his residency in anesthesia at SUNY University at Buffalo. Dr. Virk joined Great Lakes in 2014.

Dr. Virk maintains an academic affiliation with SUNY University at Buffalo. He is a member of the American Society of Anesthesiologists, Society of Pediatric Anesthesia, and the New York State Society of Anesthesiologists. He is passionate about community advocacy and advancing the patient-centric care model.

M. Karim Kechli, MD

M. Karim Kechli, MD

Clinical Assistant Professor of Anesthesiology, SUNY at Buffalo

Dr. Kechli is a Clinical Assistant Professor of Anesthesiology at SUNY at Buffalo and is a shareholder of Great Lakes Anesthesiology.

Prior to joining Great Lakes Anesthesiology in 2018, Dr. Kechli attended medical school and completed his residency at the American University of Beirut in Lebanon. After his studies, he began an academic affiliation with the SUNY University at Buffalo where he remains involved today. In addition, he is an active member of the American Society of Anesthesiologists.

Dr. Kechli is not only an expert physician and teacher but also a master in his niche, where he focuses on pediatric and obstetrical anesthesia. Having completed fellowships in this field and teaching students today to be the exceptional doctors of tomorrow makes Dr. Kechli an excellent addition to Great Lakes Anesthesiology.

Douglas Kahn, MD

Douglas Kahn, MD

Clinical Assistant Professor Anesthesiology, SUNY at Buffalo

Dr. Kahn is a Clinical Assistant Professor of Anesthesiology at SUNY at Buffalo. He was certified in 1992 by the American Board of Anesthesiology.

Dr. Kahn received his education at the Sackler School of Medicine, University of Tel Aviv in Israel in 1981. He held his anesthesia residency in Cleveland, Ohio in 1990 at the Metro Health Center.

Dr. Kahn’s professional focuses include regional, adult and pediatric anesthesia.

Justin Eckler, MD PhD

Justin Eckler, MD PhD

Clinical Instructor of Anesthesiology, SUNY at Buffalo

Dr. Eckler is a Clinical Instructor of Anesthesiology at SUNY at Buffalo. He has been certified since 2019 from the American Board of Anesthesiology.

Dr. Eckler attended medical school at SUNY at Buffalo and earned his Ph.D in pharmacology and toxicology in 2002. This is where he also held his anesthesia residency in 2012 and his pediatric anesthesia fellowship in 2013.

Dr. Eckler’s research interests include opioid receptors, obstructive sleep apnea, pain management, pharmacodynamics, and dental sedation.

Michael Weinberg, BS MD

Michael Weinberg, BS MD

Clinical Assistant Professor of Anesthesiology, SUNY at Buffalo

Dr. Weinberg is part of the UJF New Leadership Committee in the Physicians’ Division and serves as a Clinical Assistant Professor of Anesthesiology at SUNY at Buffalo. He is certified by the American Board of Anesthesiology since 1995.

Dr. Weinberg received his education from SUNY at Buffalo in 1987 and had both his anesthesia residency and pain medicine fellowship there in 1994 and 1995.

Michelle Raczka, MD

Michelle Raczka, MD

Clinical Assistant Professor of Anesthesiology, SUNY at Buffalo

Dr. Raczka is the Department Compliance Officer at Kaleida Health and serves as a Clinical Assistant Professor of Anesthesiology at SUNY at Buffalo. Dr. Raczka is certified by the American Board of Anesthesiology as of 2008 and received a subspecialty board certification in 2013 from Pediatric Anesthesiology.

She received her education at SUNY at Buffalo in 2003 where she also worked her anesthesia residency in 2007 and completed her fellowship in 2009.

Stephan Nebbia, BSc MD

Stephan Nebbia, BSc MD

Clinical Assistant Professor of Anesthesiology, SUNY at Buffalo

Dr. Nebbia serves as a clinical assistant professor of Anesthesiology at SUNY at Buffalo. He was certified by the American Board of Anesthesiology in 1995 and subsequently earned a subspecialty certification in Pediatric Anesthesiology in 2017.

Dr. Nebbia attended Rutgers Medical School in Newark, NJ. He did an internship in Pediatrics at Emory before starting Anesthesia residency at Vanderbilt. He then moved to Canada completing his residency in 1992 and completed a fellowship in Pediatric Anesthesia in 1993. He is also board certified by the Royal College of Physicians and Surgeons of Canada.

Ramiro Mireles, MD

Ramiro Mireles, MD

Clinical Assistant Professor of Anesthesiology, SUNY at Buffalo

Dr. Mireles received his certification from the American Board of Anesthesiology in 1994 and serves as a Clinical Assistant Professor of Anesthesiology at SUNY at Buffalo.

He received his education from Mount Sinai School of Medicine of NYU in 1989 and conducted his residency at Bellevue Hospital Medical Center in 1993 in New York. Following his time in NY, Dr. Mireles took on a fellowship in Washington DC at the Children’s National Medical Center in 1994 and continues to specialize in pediatric anesthesia.

Max Chudy, BS MD

Max Chudy, BS MD

Clinical Assistant Professor of Anesthesiology, SUNY at Buffalo

Dr. Chudy serves as the Clinical Assistant Professor of Anesthesiology at SUNY at Buffalo. This position holds significant honor being an alum of the University, as he completed both his pediatric anesthesia fellowship and anesthesia residency there in 1984-1985 leading into his career.

Dr. Chudy received his education at U Autonoma de Guadalajara and earned his BS degree and MD in 1979. During his studies, Dr. Chudy took great interest in pediatric anesthesia and continues his practices in this field today.

Barbara Williams

Sr. Medical Biller/Certified Medical Coder

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Donna Kibler

Sr. Medical Biller

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Melissa A. Klopfer

Credentialing Specialist

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Danielle Washington

Medical Charge Entry Specialist

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Jennifer Polizzi

Sr. Medical Biller/Certified Medical Coder

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Dawn Henderson

Credentialing Specialist

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In vim omnium offendit. Vix dico putant dicunt cu, ea eos partem praesent. Elit nostrud vim ea. No eum persius iudicabit, an consequat interpretaris est. Hinc case reque id mei.

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Jenna Weiss

Sr. Medical Biller/Certified Medical Coder

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Dianne Adams, MAOL

Dianne Adams, MAOL

Executive Assistant to the CFO/COO

Dianne Adams is Executive Assistant to Andrea Watkins, our CFO/COO. She joined the GLA team in late 2021, but boasts over 35 years of experience. She cites the diversity of ideas and the clear, open communication between the team as her favorite thing about working here.

Dianne earned an Associate’s Degree in Secretarial Science/Office Management from ECC, and two degrees from Medaille College: a Bachelor’s Degree in Business Administration, and a Master’s of Arts Degree in Organizational Leadership (MAOL).

Additionally, Dianne is a Certified Clerk typist and specializes in Medical Transcription.

Dragana Draca, MBA

Dragana Draca, MBA

Human Resource Manager

Dragana Draca is Great Lakes Anesthesiology’s HR Manager, joining the team in 2021. Company culture is her favorite part of working at GLA. “We are Empowered to Grow,” she says.

Dragana holds undergraduate degrees in Paralegal Studies and Business Administration, and a Master of Business Administration Degree, with a concentration in Leadership and Change from Canisius College.

She is active in the Society for Human Resource Management and when she is not working, Dragana can be found baking in the kitchen, spending time with her Pomsky Lola, traveling or cheering on her favorite football team. Go Bills!

Megan A. Roemer

Megan A. Roemer

Office Manager & Scheduling Specialist

A GLA team member for over 20 years, Megan Roemer is Great Lakes Anesthesiology’s Office Manager and Scheduling Specialist.

Megan is a certified Surgical Tech, and has an Associate’s Degree in Surgical Technology from Niagara County Community College.

A team member since 2002, Megan knows a great deal about the teamwork culture at GLA.

“When all clinical and nonclinical staff collaborate effectively, healthcare teams can improve patient outcomes and increase patient satisfaction.”

Stacey Watt, MD, MBA, MHPE, FASA

Stacey Watt, MD, MBA, MHPE, FASA

Site Director - Oishei Children's Hospital, Chief of Anesthesia - Kaleida Health

Dr. Watt wears many hats, serving as the Chief of Anesthesia for Kaleida Health, Site Director for Oishei Children’s Hospital, and the Program Director of the Anesthesia Residency & Pediatric Anesthesia Fellowship at University at Buffalo’s Jacobs School of Medicine and Biomedical Sciences. She was board certified by the American Board of Education in 2007, earning a subspecialty certification in Pediatric Anesthesiology in 2014.

Dr.Watt followed her medical degree from SUNY Upstate Medical University in 2001 with a residency at University at Buffalo in 2005, where she was also fellowship-trained in Pediatric Anesthesia in 2007.

Like many of her GLA colleagues, Dr. Watt serves as a Clinical Professor of Anesthesiology at University at Buffalo’s Jacobs School of Medicine and Biomedical Sciences. Her other specialities include malignant hyperthermia, heat related illness and injury, and trauma and emergency preparedness.

Michael Marino, MD

Michael Marino, MD

Board of Directors At Large Member

Dr. Marino earned his board certification from the American Board of Anesthesiologists (ABA) in 1997, and a subspecialty certification in Pediatric Anesthesiology from the ABA in 2016. He serves as an At Large Member of the Board of Directors at Great Lakes Anesthesiology.

Dr. Marino earned a medical degree from the University at Buffalo in 1990, and completed a residency at the school in 1995. He is fellowship-trained in Adult Critical Care Medicine from the University at Buffalo.

Dr. Marino serves as a Clinical Assistant Professor of Anesthesiology at University at Buffalo. His other specialties are in Regional and Pediatric Anesthesia.

Marybeth Sgroi, CPC

Marybeth Sgroi, CPC

Billing Manager

Marybeth Sgroi has more than 30 years of professional experience. She joined the GLA team in 2007, and is currently our Billing Manager.

“Being part of the GLA team for the past 15 years has given me the opportunity to watch the corporation grow and work with an exceptional team of providers and administrative staff.”

Her education is in business, in which she holds an associate’s degree from SUNY Canton. Marybeth is also an AAPC Certified Medical Coder.

Outside of GLA, Marybeth is an active volunteer with Churches in Action, and a Black Belt in Karate.