Physician Profile: David G. Nazarian, MD
Fall 2004
David
G. Nazarian, MD, a knee and hip surgeon
and director
of the hip surgery program at Booth, Bartolozzi,
Balderston
Orthopaedics, is a member of the Center for Bloodless
Medicine and Surgery (CBMS) at Pennsylvania Hospital.
Bloodless Orthopaedic Surgical
Techniques
Working with the Center for Bloodless Medicine
and Surgery staff, Dr. Nazarian uses a variety
of
methods before, during and after surgery to control
and decrease the amount of blood loss during
knee or
hip surgery. “Orthopaedic
surgery that involves the bones may
cause more bleeding,” Dr. Nazarian said. “Bone
is a
very vascular tissue.When you cut the bone, unlike
soft tissue, you can't suture the bone
to stop the
bleeding,” Dr. Nazarian explained.
“We
use minimally invasive surgical techniques that
involve a three-inch incision rather than the
traditional 12-inch incision for both knees and
hips.
This smaller incision and less muscle cutting
decreases blood loss,” Dr. Nazarian said.
Other techniques used during joint replacement
surgery that help to decrease blood loss include
hypotensive anesthesia and regional anesthesia. “Hypotensive
anesthesia gently lowers blood pressure,” Dr.
Nazarian said. Regional anesthesia,
commonly known as a spinal or epidural, can also
effectively lead to a decrease in the amount
of
blood loss.
In addition, using epidural catheters
for postoperative pain management has been shown
to decrease blood pressure after total knee and
hip
replacement surgery and affords a comfortable,
painless recovery. “We use spinals for
the procedure
and epidural catheters with pain medication after
surgery.This also will lower blood pressure slightly
and decrease blood loss,” Dr. Nazarian
said.
Dr.Nazarian noted that these innovative
techniques are available to all patients undergoing
surgical treatment in his orthopaedic practice.
Preparing
for Surgery
Some patients may prefer not to receive
transfusions from a blood bank or to donate their
own blood several weeks before surgery, also
called
preoperative autologous blood donation. The Center
for Bloodless Medicine and Surgery at Pennsylvania
Hospital assists patients choosing the bloodless
approach in several ways.
Patients may be treated in advance with a
naturally occurring growth factor called epoetin
alfa - commonly known as PROCRIT® - which
stimulates the bone to make red blood cells. “If
a
patient's hemoglobin is less than 13, then
the
patient is a good candidate for PROCRIT®
injections since it builds the blood count,” Dr.
Nazarian explained.
“With
PROCRIT®,
patients do not become anemic and it prevents
the need for transfusions,”
Dr. Nazarian said .“This is an excellent
option for
people looking to avoid transfusions.”
Another method, called acute normovolemic
hemodilution (ANH), allows patients to use their
own blood just before the surgery. Dr. Nazarian
is
one of the few surgeons in Pennsylvania using
this
technique for hip and knee replacement surgery.
Dr. Nazarian noted that some recent studies have
shown that this technique is as effective or
even
more effective than donating blood two or three
weeks prior to surgery.
By choosing ANH, the
blood
does not get old or lose its ability to carry
oxygen. In
addition, patients always receive their own blood.
Each of the blood management techniques used
individually or in combination has dramatically
reduced the need for banked blood in Dr. Nazarian's
patients. Patients who maintain a higher blood
count have fewer complications and leave the
hospital more quickly.They are often able to
rapidly
return to an active lifestyle.
About Dr. Nazarian
Dr.
Nazarian is a clinical
assistant professor of
orthopaedic surgery at Pennsylvania Hospital.
After
receiving his medical degree from Columbia
University in New York City, he completed his
internship and residency at Columbia-Presbyterian
Medical Center and his fellowship at Thomas
Jefferson University Hospital. Dr. Nazarian is
board certified in
orthopaedic surgery and performs over
1,000 hip and knee replacements each year.
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