Perioperative medicine & outcomes
Intraoperative Use of Phenylephrine versus Ephedrine and Postoperative Delirium: A Multicenter Retrospective Cohort Study
Authors' conclusion
The administration of phenylephrine compared to ephedrine during general anesthesia was associated with higher odds of developing postoperative delirium.
Study context
- Population
- Hospitalized adults undergoing GA for noncardiac, non-neurosurgical procedures, 2008–2020, two tertiary academic healthcare networks in Massachusetts770 (0.8%) developed delirium
- Participants
- 103,094 adults
- Exposure
- Intraoperative phenylephrine vs ephedrine
- Phenylephrinen = 78,982
- Ephedrinen = 24,112reference
- Outcome
- Postoperative delirium
- Follow-up
- Within 7 days
Methodological detailsmulticentre hospital registry, multivariable logistic regression adjusted for a priori confounders
- Multicentre hospital registry
- Multivariable logistic regression adjusted for a priori confounders
Main finding
As reported in the abstract
Postoperative delirium within 7 days
Each group vs ephedrineAdjusted odds ratio (95% CI)P value
Phenylephrine
1.35(1.06–1.71)
P = 0.015Each group vs ephedrineAdjusted absolute risk difference (95% CI)P value
Phenylephrine
0.2%(0.1–0.3%)
P = 0.015Observational data: associations, not effects.
Further findings
| Outcome | aOR (95% CI) | P value | |
|---|---|---|---|
| Delirium by keyword and manual chart review (validation subset)Subset of 45,465 patients; delirium incidence 3.2% | 1.88 (1.49–2.37) | P < 0.001 | |
| 0.512Adjusted odds ratio (log scale) |
Total intraoperative vasopressor dose
| Outcome | Adjusted coefficient (95% CI) | P value |
|---|---|---|
| Dose-dependence of phenylephrine (fractional polynomial regression)Per each μg/kg increase in cumulative phenylephrine dose | 0.08 (0.02–0.14) | P = 0.013 |
Original publication
Intraoperative Use of Phenylephrine versus Ephedrine and Postoperative Delirium: A Multicenter Retrospective Cohort Study. Anesthesiology. Published 19 September 2023. doi:10.
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