Derek Smith (@derekedsmith) header
Derek Smith (@derekedsmith) profile picture

Anesthesia | Sports | Novels | The great outdoors. Wander where the Wifi is weak.

Muskoka, Ontario
Joined September 2021
Photo by Derek Smith (@derekedsmith)Photo by Derek Smith (@derekedsmith)Photo by Derek Smith (@derekedsmith)Photo by Derek Smith (@derekedsmith)Photo by Derek Smith (@derekedsmith)Photo by Derek Smith (@derekedsmith)Photo by Derek Smith (@derekedsmith)Photo by Derek Smith (@derekedsmith)Photo by Derek Smith (@derekedsmith)Photo by Derek Smith (@derekedsmith)
New study: IV dexamethasone may extend C-section spinal anesthesia, adding ~21 minutes of motor block without more pain, opioid use, nausea or itching. anesthesiologynews.com/Clini… #Anesthesia #CSection #ERAC
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Why does more norepinephrine sometimes make things worse? In some patients, afterload outruns contractility, ventriculo-arterial coupling falls apart, and stroke volume drops. 🎩 tip to the authors. eddyjoemd.com/foamed
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A new special article is available in Anesthesiology Open now! Read "American Society of Anesthesiologists Guidance on Periprocedural Fasting in Patients Receiving Tube Feeding," online: ow.ly/cfHv5102gPV
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Derek Smith retweeted
Pickle juice sips can stop muscle cramps and improve cramp severity in #cirrhosis: The PICCLES RCT Why we did this study? 1⃣Cramps are common 2⃣Cramps trash quality of life 3⃣Treatments are 💩 Paper: journals.lww.com/ajg/abstrac… #LiverTwitter
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A battle has been unfolding in Elora, one of Ontario's most picturesque towns. Developer Kat Florence has helped transform it into a luxury destination. But critics say the tourism boom has strained the community and given the company too much influence. theglobeandmail.com/canada/a…
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Neurolysis of the pericapsular nerve group: a ‘plan B’ in palliative care after hip fracture? "Finding a way of providing sustained analgesia for patients who have chosen/are only suitable for non-operative management remains an important unmet need." #anaesthesia #MedTwitter #MedX doi.org/10.1111/anae.70443
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Dr. Berman said that esmolol would decrease the sympathetic response to laryngoscopy but that it was NOT a “pain medication” and shouldn’t be thought of as a pain medication. Which got me thinking…🧵
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I may have been wrong to think that giving calcium in septic shock was like providing bug food. The authors seem to be saying, "depends on how sick." No benefit without pressors, and a bigger gain as the NE dose climbs. 🎩 tip to the authors eddyjoemd.com/foamed
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Blocks for Bunions: Bupivacaine, 2–3 mL per nerve supplying the operative toe + for patients who need to stay completely awake (no sedation at all, e.g., EF 5%): lidocaine popliteal sciatic block 🤓💉🦶
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Given the high short term mortality risk in this particular scenario, I would also discuss non-operative management combined with a phenol nerve block with the patient and her family. pubmed.ncbi.nlm.nih.gov/4271…
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Derek Smith retweeted
Very thoughtful option — in our hospital the operative rate for hip fracture approaches 99% (some of that is driven by family pressure) but we do make some palliative. Love the phenol ablative PENG block or, more recently, cryoneurolysis for that population. #Blocktober26
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Replying to @dsaorthocaucus
Also funny when your hospital says you can’t do a surgery on a 17 year 300 day year old that’s 6 feet tall and 200 pounds because they’re a peds patient but no issue with the 85 year old 90 lb woman on 6 blood thinners and a EF of 20%.
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In a large, multicenter, randomized phase 4 trial published in The Lancet Respiratory Medicine, sugammadex reduced the risk of postoperative pulmonary complications compared to neostigmine. Read a summary in the October 2026 SM&A: ow.ly/3Fe250ZVauW
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Derek Smith retweeted
Haha yes googly eyes! I’ve also heard that described as owl eyes and Scooby Doo eyes. When the trainees finish the block they’re always in a hurry to pull the needle out and put the probe away—I insist they do a “victory lap” and slide distal to see this beautiful sign…
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How much (approximately) do the vasoactive medications we use cost? 🎩 tip to the authors including @SXC71 @pwierusz and Ortoleva who I had the pleasure of meeting yesterday at #ELSO2026 eddyjoemd.com/foamed
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Derek Smith retweeted
This week in medicine 1. Dana-Farber/23andMe show that a rare inherited EGFR mutation increases lung-cancer risk 25-fold - and 62-fold in never-smokers. 2. City of Hope researchers develop a new blood test that detects early stage (I–II) pancreatic cancers with ~87% sensitivity - by combining a 10-miRNA signature with the existing test, CA19-9. Bigger trials up next. 3. Novo’s CagriSema delivers 19% placebo-adjusted weight loss in a phase 3 obesity trial - and, in a separate phase 3 trial in type 2 diabetes, beats low-dose tirzepatide for weight loss (12.4% vs 9.1%). 4. Mayo Clinic/n-Lorem researchers develop a personalized antisense oligonucleotide for a single patient with CHCHD10-mutant ALS. After a year, markers of neuronal damage dropped, and clinical/lung function stabilized or even improved. 5. GenFleet’s oral KRAS G12D ON/OFF inhibitor produces responses against both pancreatic and lung cancer in a phase 1 trial - and moves straight to phase 3. Its differentiation is that it targets both active and inactive KRAS. 6. Brigham researchers find evidence that Epstein–Barr virus reactivation precedes multiple sclerosis relapses by weeks to months. 7. Stanford researchers build a Virtual Biotech, with >37,000 AI agents - finding that drugs targeting cell-type-specific genes were 48% more likely to get approved, with 32% fewer adverse events. 8. Bayer’s finerenone gets FDA-approved for chronic kidney disease in type 1 diabetes - the first new treatment for this population in more than 30 years. 9. Stanford researchers find that the anti-seizure drug, levetiracetam, may directly inhibit diffuse midline glioma. Children taking it had longer survival (in retrospective cohorts) - prospective trials up next. 10. A European trial finds that, after removal of high-risk colorectal adenomas, waiting 5 years for the first surveillance colonoscopy is just as good as doing one after 3 years - potentially almost halving the number of follow-up colonoscopies needed.
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Derek Smith retweeted
Big news - Jehovah’s Witnesses can receive PRBC, platelets FFP etc if they want jw.org/en/global-communicati…
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So basically, if you have a diabetic patient with high ischemic risk, long term monotherapy with Plavix, after standard dual antiplatelet therapy, may provide lower ischemic events compared with aspirin only with similar bleeding rates. I have observed this in practice too. Congratulations to JACC Interv on great paper 👇
Clopidogrel vs Aspirin According to Diabetes Mellitus: A Prespecified Analysis of the SMART-CHOICE 3 Trial: @JACCJournals 🥸 Plavix only as monotherapy in patients with DM: SMART-CHOICE 3 😱 Nice paper in JACC Interv 👇👇👇👇
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