Clinical Resources for Physicians

Perioperative care requires seamless collaboration between surgical and anesthesia teams to ensure optimal patient outcomes. At Great Lakes Anesthesiology, we’re committed to sharing evidence-based protocols and clinical guidelines that support best practices across our partner facilities.

Below, you’ll find current clinical resources, perioperative algorithms, and evidence-based recommendations developed by our team. These resources reflect the latest literature and professional society guidelines to help inform clinical decision-making and enhance patient safety.

For additional clinical questions or to discuss specific cases,
please don’t hesitate to contact our team directly.

Fasting Before Elective Surgery
Elective surgery in the child with a URTI
Common Questions

Fasting Guidelines for Healthy Children Undergoing Elective Surgery

The fasting guidelines for healthy children undergoing elective surgery at Oishei Children’s Hospital are as follows:

  1. CHILDREN SHOULD DRINK CLEAR FLUIDS up to TWO (2) hours before the scheduled surgery time
    • Clear fluids include fluids without pulp such as apple juice, Gatorade or a similar clear drink and clear jello.
    • DO NOT GIVE ORANGE JUICE or MILK at this time!
  2. BREASTMILK up to FOUR (4) hours before the scheduled surgery time
  3. COW’S MILK and FORMULA up to SIX (6) hours before the scheduled surgery time
  4. SOLID FOODS at least EIGHT (8) hours before the scheduled surgery time

 NOTE: Children should expel gum before surgery. Chewing gum should not delay surgery. However, if the gum is swallowed, the child’s surgery will be canceled. Eating or drinking any foods other than those listed above may result in the anesthetic being delayed or canceled.

These are only guidelines. Individuals with medical conditions that could delay gastric emptying or increase the risk of aspiration may have these fasting guidelines modified.

Elective Surgery
in a Child with a URTI

Elective Surgery in a Child with a URTI

Download PDF >>

J. Lerman MD, 03/2025

Frequently asked questions.

What should I know about my patient's GLP-1 medications (e.g., semaglutide [Ozempic]) when preparing them for surgery or 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 about medications on the day of surgery?

Patients may take most medications with a small sip of a clear fluid on the day of surgery.

Drugs that should be taken on the day of surgery include:

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

Patients should NOT be take the following on the day of surgery:

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

GLP-1 medications should NOT be taken for at least one week before the day of surgery: The American Society of Anesthesiologists recommends holding the last dose of medication before their procedure. Example, if the patient takes the GLP-1 on Mondays and their surgery is on a Tuesday, do NOT take the GLP-1 on the Monday immediately before the day of surgery. However, this alone might not be enough to reduce the risk, so other precautions might be needed.

Contrave (an opioid agonist/antagonist) should not be taken for 3 days before surgery.

For medications not listed, please call our office (716-323-6570) for details.

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

What should I know about my patients taking SGLT2i medications (e.g., empagliflozin [Jiardiance]) for type 2 diabetes mellitus when preparing them for surgery or anesthesia?

This class of medications presents concerns about the perioperative risks of developing euglycemic diabetic ketoacidosis after an overnight fast. Currently, we recommend withholding these medications for 3 days before surgery.

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

At Large Member, Board of Directors|Site Director, Buffalo Ambulatory Surgery Center (BASC)|Site Director, Atlas Surgery Center|Director of Fellowship

Dr. Jerrold Lerman is Director of Fellowship and At Large Member of the Board of Directors at Great Lakes Anesthesiology and Site Director at Buffalo Ambulatory Surgery Center (BASC). Dr. Lerman is also the Program Director, Pediatric Anesthesiology Fellowship, SUNY at Buffalo Jacobs School of Medicine and Biomedical Sciences.

Dr. Lerman has over 40 years of clinical experience and is board certified in the United States and Canada. He earned a BASc 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.

He is board certified in Anesthesiology and Pediatric Anesthesia from the ABA and a fellow of the Royal College of Physicians and Surgeons (FRCPC) in Canada. He is an honorary fellow of the Australia and New Zealand College of Anesthetists (FANZCA). He has been Clinical Professor of Anesthesiology at the Jacobs School of Medicine and Biomedical Sciences in Buffalo since joining the department in 2002. His areas of expertise is pediatric anesthesia with research interests in inhaled anesthetics and the pediatric airway. He is a member of the ASA, Society for Pediatric Anesthesia, the New York State Society of Anesthesiologists, Association of Pediatric Anesthesiologists of Great Britain and Ireland (APAGBI), and a member of the European Association of Pediatric Anesthetists (ESPA).

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."

M. Karim Kechli, MD

M. Karim Kechli, MD

At Large Member, Board of Directors|Clinical Assistant Professor of Anesthesiology, SUNY at Buffalo

Dr. Kechli is an At Large Member of the Board of Directors of Great Lakes Anesthesiology and a Clinical Assistant Professor of Anesthesiology at SUNY at Buffalo.

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.

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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Dawn Henderson

Credentialing Specialist

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Jenna Weiss

Sr. Medical Biller/Certified Medical Coder

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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.

Et sea error dolore. An nusquam mentitum disputando cum. Probatus consequat pri at, ex eos tantas interpretaris. Dicant noster persequeris et vel, graece offendit quo ut. Mei latine detraxit eu, ut vim quas principes, oblique accommodare est et.

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

Clinical Professor of Anesthesiology, SUNY at Buffalo

Dr. Watt is 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

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. 

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.

Name

Position

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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.

Et sea error dolore. An nusquam mentitum disputando cum. Probatus consequat pri at, ex eos tantas interpretaris. Dicant noster persequeris et vel, graece offendit quo ut. Mei latine detraxit eu, ut vim quas principes, oblique accommodare est et.

Huseyin Tunceroglu, MD, MBA

Huseyin Tunceroglu, MD, MBA

Vice President, Board of Directors|Site Director, Olean General Hospital

Dr. Huseyin Tunceroglu is Vice President of the Board of Directors at Great Lakes Anesthesiology and the anesthesia Site Director at Olean General Hospital in Olean, NY. He is certified by the American Board of Anesthesiology and specializes in Pediatric Anesthesiology.

After earning his bachelor's degree at Yale University, Dr. Tunceroglu attended medical school at SUNY University at Buffalo. He returned to Yale University for his residency, then completed a Pediatric Fellowship at Emory University. In 2022, he earned an MBA from Canisius College. Dr. Tunceroglu joined Great Lakes Anesthesiology in 2018 to "Be part of an outstanding team of anesthesia providers delivering the highest quality care while helping to shape and educate future anesthesiologists and nurse anesthetists."

In addition to his clinical duties, Dr. Tunceroglu maintains an academic affiliation with SUNY University at Buffalo. He is a member of the American Society of Anesthesiologists, Society of Pediatric Anesthesia, and New York State Society of Anesthesiologists.

Mark Thompson, MD

Mark Thompson, MD

Director of Regional Anesthesia

Dr. Thompson is the Director of Regional Anesthesia at Great Lakes Anesthesiology.

With nearly two decades of experience, he specializes in Neuroanesthesia, regional anesthesia, pediatric anesthesia, and ambulatory anesthesia. Dr. Thompson is certified by the American Board of Anesthesiology and has demonstrated ongoing excellence through Maintenance of Certification in Anesthesiology (MOCA) since 2014.

Dr. Thompson graduated with a bachelor’s degree in psychology from Atlantic Union College in South Lancaster, MA. He then completed medical school, his internship, and his residency at Loma Linda University in Loma Linda, CA. Additionally, he is fellowship-trained in pediatric anesthesiology from Children’s Hospital Colorado in Aurora, CO.

He joined Great Lakes in 2015 and appreciates the company’s collaborative solutions, team spirit, and commitment to the community. Beyond his practitioner duties, Dr. Thompson is a Clinical Associate Professor at SUNY University at Buffalo. He is a member of the American Society of Anesthesiologists, Society of Pediatric Anesthesia, and New York State Society of Anesthesiologists.

Outside of work, Dr. Thompson devotes his time and attention to family, fitness, and faith.

Cyrus Tanhaee, MD

Cyrus Tanhaee, MD

Dr. Cyrus Tanhaee is the Educational/Clinical Committee Representative at Great Lakes Anesthesiology. He is board certified by the American Board of Anesthesiology with subspecialty board certification in pediatric anesthesiology.

Dr. Tanhaee attended Ross University School of Medicine in Dominica. He completed his residency and fellowship in pediatric anesthesia at SUNY University at Buffalo. In addition to his practitioner duties, Dr. Tanhaee is a Clinical Assistant Professor of Anesthesiology at SUNY University at Buffalo.

Lilleigh Stein, CRNA

Clinical Coordinator - Olean General Hospital

Lilleigh Stein is the Clinical Coordinator at Olean General Hospital in Olean, NY. She’s been a member of the Great Lakes Anesthesiology team since 2019 and appreciates the group's family atmosphere.

Lilleigh conducted her undergraduate studies at Trocaire College and Daemen College, then attended graduate school at Gannon University. She completed her nurse anesthesia residency at UPMC Hamot in Erie, PA. She is a member of the American Association of Nurse Anesthesiology (AANA), Pennsylvania Association.

Baiba Senbruna, MD

Baiba Senbruna, MD

Director of Obstetrics Anesthesiology, Oishei Children's Hospital

Dr. Baiba Senbruna is the Director of Obstetrics Anesthesia at John R. Oishei Children's Hospital. With nearly a decade of experience, her specialties include high-risk obstetrical anesthesia and pediatric anesthesia.

Dr. Senbruna completed medical school at Riga Stradins University in Latvia and fulfilled her residency at the American University of Beirut in Lebanon. She is a member of the American Society of Anesthesiologists and the Society of Pediatric Anesthesia and serves as volunteer faculty at SUNY University at Buffalo.

A member of Great Lakes Anesthesiology since 2017, Dr. Senbruna appreciates, among other attributes, our “progressive, supportive environment that encourages individual professional growth and provides opportunities in clinical leadership.” She is an avid traveler who enjoys learning and experiencing different cultures and embarking on medical missions.

Jad Dughayli, MD

Jad Dughayli, MD

Treasurer, Board of Directors|Site Director, Kenmore Mercy Hospital|Chief of Anesthesia, Kenmore Mercy Hospital|Director of Fellowship Recruitment

Dr. Jad Dughayli is Treasurer of the Board of Directors and Fellowship Recruitment Liaison at Great Lakes Anesthesiology. He also serves as Site Director and Chief of Anesthesia at Kenmore Mercy Hospital.

Prior to joining Great Lakes Anesthesiology in 2018, Dr. Dughayli attended medical school at the American University of Integrative Sciences in Barbados, then completed his residency at the American University of Beirut in Lebanon. He maintains an academic affiliation with SUNY University at Buffalo.

Ravinder Devgun, DO

Ravinder Devgun, DO

Secretary, Board of Directors and At Large Member|Clinical Assistant Professor of Anesthesiology, SUNY at Buffalo

Dr. Ravinder Devgun is Secretary of the Board of Directors at Great Lakes Anesthesiology and a clinical assistant professor of Anesthesiology at SUNY at Buffalo. She is board certified by the American Board of Anesthesiology with a subspecialty certification in pediatric anesthesiology.

Dr. Ravinder Devgun graduated from the NY Institute of Technology, College of Osteopathic Medicine. She completed her residency and fellowship at SUNY University at Buffalo.

Dené Dainotto, CRNA, DNP

Clinical Coordinator - UB SRNA Program at KMH

Dené is the Clinical Coordinator of the UB SRNA Program at Kenmore Mercy Hospital in Buffalo, NY. She joined Great Lakes in 2020, and her areas of interest include regional anesthesia, pediatric anesthesia, and obstetric anesthesia.

Dené completed her education and training at SUNY University at Buffalo, earning her B.S. and then her Doctor of Nursing Practice (DNP) in Nurse Anesthesia. She has practiced at several hospitals and surgery centers around Western New York and holds the National Board of Certification and Recertification for Nurse Anesthetists.

Returning to her alma mater, Dené serves as adjunct faculty at SUNY University at Buffalo. She is a member of the American Association for Nurse Anesthesiologists and the New York State Association of Nurse Anesthetists.

Her favorite aspects of working at Great Lakes include caring for diverse patient populations and the group's teaching and learning environment. In her personal time, Dené is a national judge for the United States Powerlifting Association.

Richard Boneberg, CRNA

Clinical Coordinator - UB SRNA Program at OCH/NFMMC

Richard Boneberg is Great Lake Anesthesiology's Clinical Coordinator for the UB SRNA Program at Oishei Children's Hospital in Buffalo, NY, and Niagara Falls Memorial Medical Center in Niagara Falls, NY. He has 17 years of experience specializing in pediatric nurse anesthesia, and has been a member of the Great Lakes team since 2005.

Richard earned a B.A. in Psychology at Canisius College, a B.S. in Nursing at D'Youville University, and a Master of Science from the SUNY University at Buffalo Nurse Anesthetist Program. He holds numerous certifications, including Basic Life Support Provider, Pediatric Life Support Provider, Adult Cardiac Life Support Provider, Registered Professional Nurse, and Certified Registered Nurse Anesthetist.

An avid supporter of education, Richard serves as an adjunct professor at two institutions – SUNY University at Buffalo and SUNY Albany – and is a co-facilitator with Statewide Peer Assistance for Nurses (SPAN). He is also a member of the American Association for Nurse Anesthetists.

After two decades of being part of Great Lakes Anesthesiology, Richard describes the group as feeling like family. "There is a cohesive, caring atmosphere. The group's uniqueness is exemplary." In his personal time, Richard is an advocate and consultant for substance abuse. He enjoys cycling, playing with his dogs, and spending time with his family.

Dayle Cotter

Dayle Cotter

Operations Coordinator

Dayle Cotter is Great Lake Anesthesiology's Operations Coordinator, providing strategic operational support to the management and administrative teams to ensure our success and growth. She joined Great Lakes in January 2022 and appreciates the company's best-in-brand philosophy and family atmosphere.

Dayle earned her B.A. from Brock University in St. Catharine's, Ontario, Canada. She completed Disney's Approach to Quality Service & Business Excellence from the Disney Institute. Her areas of expertise include strategic planning, public relations, process implementation, and event planning. She is also an NYS Notary Public. Dayle loves to travel and enjoys playing golf and tennis.

Andréa Watkins, MSSL

Andréa Watkins, MSSL

Chief Financial Officer and Chief Operating Officer

Andréa Watkins is the Chief Financial Officer and Chief Operations Officer at Great Lakes Anesthesiology. Since joining the company in 2009, she has cherished the opportunity to "be a part of a dynamic, growing corporation while preserving the phenomenal interpersonal connections of the Great Lakes family."

Andréa holds a B.A. from the University at Buffalo, a B.S. from St. John Fisher University, and a Master's in Strategic Leadership (MSSL) from Roberts Wesleyan College. She is a member of the American Society of Anesthesiologists (ASA) and the Society for Human Resource Management (SHRM).

Nancy O'Day, CRNA

Chief CRNA, Warren General Hospital

Nancy Day is the Chief CRNA at Warren General Hospital in Warren, PA. She also serves as CNRA at Olean General Hospital in Olean, NY. Nancy has nearly 40 years of nursing experience, including 23 years as a certified CNRA. She joined our group in 2019 and has enjoyed working closely with the Great Lakes family.

Nancy earned her undergraduate degree at Syracuse University, then attended Northeastern University for her graduate studies. She completed her nurse anesthesia residency at Tufts Medical Center in Boston, MA. She is certified as an instructor for Basic Life Support (BLS), Pediatric Advanced Life Support (PALS), and Advanced Cardiovascular Life Support (ACLS). Her professional memberships include the American Association of Nurse Anesthesiology (AANA), Pennsylvania Association of Nurse Anesthetists (PANA), and Sigma Theta Tau International Honor Society of Nursing.

Nancy's favorite pastime is cooking. She is also active within the community through organizations such as the Smethport Area School District school board, American Legion, Women's Giving Circle of McKean County, and the American Heart Association.

James Burnett Armstrong, BSc, MSc, MD, FRCPC

James Burnett Armstrong, BSc, MSc, MD, FRCPC

Site Director, Atlas Surgical Center

Dr. James Armstrong is the anesthesia Site Director at Atlas Surgical Center, Buffalo, and Niagara Ambulatory Surgery Center in Niagara Falls, NY. One of our longest-tenured team members, Dr. Armstrong joined Great Lakes Anesthesiology in 1998.

Dr. Armstrong completed his education and training at the prestigious Queen's University in Kingston, Ontario, Canada, plus a fellowship at the Cleveland Clinic in Ohio. He is certified by the American Board of Anesthesiology.

Beyond his practice, Dr. Armstrong is the Clinical Assistant Professor of Anesthesiology at SUNY University at Buffalo. In 2012-13 he received the WCHOB Teacher Recognition Award.

He is a member of several professional organizations, including The Royal College of Physicians & Surgeons of Canada, American Society of Anesthesiologists, New York State Society of Anesthesiologists, and Society of Ambulatory Anesthesia.

Navyugjit S. Virk, MD

Navyugjit S. Virk, MD

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

Dr. Virk is the President of Great Lakes Anesthesiology, OR Coordinator at Oishei Children’s Hospital, and Co-Site Director at Warren General Hospital (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 academic affiliations with SUNY University at Buffalo and Lake Erie College of Osteopathic Medicine (LECOM). 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.