---
title: "Phenylephrine vs Ephedrine for Preventing Postoperative Delirium in Elderly Patients: Trial Protoc"
id: "pubmed-42745683"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42745683"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42745683/"
doi: "10.1080/07853890.2026.2732555"
published_at: "2026-09-16T09:46:03.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Phenylephrine vs Ephedrine for Preventing Postoperative Delirium in Elderly Patients: Trial Protoc
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42745683
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42745683/)
- **DOI:** [10.1080/07853890.2026.2732555](https://doi.org/10.1080%2F07853890.2026.2732555)
- **Published At:** 2026-09-16T09:46:03.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Background: The trial addresses whether intraoperative use of **ephedrine** versus **phenylephrine** to treat hypotension affects the incidence of **postoperative delirium** in elderly patients undergoing major non-cardiac, non-neurosurgical procedures. - Study design: Multicentre, randomized, double-blind, controlled trial conducted at seven hospitals in China, registered in the Chinese Clinical Trial Registry (ChiCTR2500115385). - Population and sample size: Planned enrollment of 1,084 elderly patients scheduled for elective major surgery under general anaesthesia; includes aged groups up to 80 and over as captured in MeSH terms. - Intervention: Continuous intravenous infusion of either phenylephrine or ephedrine begun to maintain mean arterial pressure within 20% of the patient’s baseline value. - Randomization and blinding: 1:1 randomization stratified by study centre; both patients and investigators blinded to allocation. - Primary outcome: Incidence of postoperative delirium within 7 days after surgery. - Secondary outcomes: Severity of delirium; pain numeric rating scores at rest and during activity at 24, 48, and 72 hours postoperatively; ICU admission rate and ICU length of stay; overall postoperative hospital length of stay; incidence of in-hospital major adverse cardiovascular and cerebrovascular events (myocardial infarction, arrhythmia, heart failure, stroke); and 30-day all-cause mortality. - Hypothesis: The investigators hypothesize that intraoperative management of hypotension with **ephedrine** is superior to **phenylephrine** in reducing postoperative delirium in this vulnerable population. - Rationale: Uncertainty exists whether choice of vasoactive agent to correct intraoperative hypotension influences postoperative cognitive outcomes; the trial seeks to provide high-quality evidence for optimizing intraoperative blood pressure management in elderly patients. - Publication and identifiers: Protocol published in Ann Med; PMID 42745683; DOI 10.1080/07853890.2026.2732555. - Limitations of available report: The source provides protocol overview and outcomes but does not report trial results, detailed eligibility criteria, dosing regimens, monitoring algorithms, statistical analysis plans, or safety monitoring details in the abstract.
## Clinical Analysis & Structured Key Points
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Epub 2026 Sep 16. # Effect of phenylephrine versus ephedrine on the incidence of postoperative delirium in elderly patients undergoing non-cardiac and non-neurosurgical procedures: protocol for a multicentre, double-blind, randomized, controlled trial [Xiaoxiao Xu](https://pubmed.ncbi.nlm.nih.gov/?term=Xu+X&cauthor_id=42745683)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42745683/#full-view-affiliation-1 "Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42745683/#full-view-affiliation-2 "Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42745683/#full-view-affiliation-3 "Department of Anesthesiology, The Fifth People's Hospital of Huai'an, Huai'an, Jiangsu, China."), [Gang Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+G&cauthor_id=42745683)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42745683/#full-view-affiliation-1 "Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42745683/#full-view-affiliation-2 "Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China."), [Xinyu Li](https://pubmed.ncbi.nlm.nih.gov/?term=Li+X&cauthor_id=42745683)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42745683/#full-view-affiliation-1 "Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42745683/#full-view-affiliation-2 "Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China."), [Ke Peng](https://pubmed.ncbi.nlm.nih.gov/?term=Peng+K&cauthor_id=42745683)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42745683/#full-view-affiliation-1 "Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42745683/#full-view-affiliation-2 "Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China."), [Hong Liu](https://pubmed.ncbi.nlm.nih.gov/?term=Liu+H&cauthor_id=42745683)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42745683/#full-view-affiliation-4 "Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA, USA."), [Fuhai Ji](https://pubmed.ncbi.nlm.nih.gov/?term=Ji+F&cauthor_id=42745683)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42745683/#full-view-affiliation-1 "Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42745683/#full-view-affiliation-2 "Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China."), [Xisheng Shan](https://pubmed.ncbi.nlm.nih.gov/?term=Shan+X&cauthor_id=42745683)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42745683/#full-view-affiliation-1 "Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42745683/#full-view-affiliation-2 "Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China."), [Yulan Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+Y&cauthor_id=42745683)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42745683/#full-view-affiliation-1 "Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42745683/#full-view-affiliation-2 "Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China.") Affiliations Expand ### Affiliations * 1 Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China. * 2 Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China. * 3 Department of Anesthesiology, The Fifth People's Hospital of Huai'an, Huai'an, Jiangsu, China. * 4 Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA, USA. * PMID: **42745683** * DOI: [ 10.1080/07853890.2026.2732555 ](https://doi.org/10.1080/07853890.2026.2732555) Item in Clipboard Randomized Controlled Trial # Effect of phenylephrine versus ephedrine on the incidence of postoperative delirium in elderly patients undergoing non-cardiac and non-neurosurgical procedures: protocol for a multicentre, double-blind, randomized, controlled trial Xiaoxiao Xu et al. Ann Med. 2026 Dec. Show details Display options Display options Format Abstract PubMed PMID Ann Med Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Ann+Med%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Ann+Med%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42745683/) . 2026 Dec;58(1):2732555. doi: 10.1080/07853890.2026.2732555. Epub 2026 Sep 16. ### Authors [Xiaoxiao Xu](https://pubmed.ncbi.nlm.nih.gov/?term=Xu+X&cauthor_id=42745683)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42745683/#short-view-affiliation-1 "Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42745683/#short-view-affiliation-2 "Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42745683/#short-view-affiliation-3 "Department of Anesthesiology, The Fifth People's Hospital of Huai'an, Huai'an, Jiangsu, China."), [Gang Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+G&cauthor_id=42745683)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42745683/#short-view-affiliation-1 "Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42745683/#short-view-affiliation-2 "Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China."), [Xinyu Li](https://pubmed.ncbi.nlm.nih.gov/?term=Li+X&cauthor_id=42745683)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42745683/#short-view-affiliation-1 "Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42745683/#short-view-affiliation-2 "Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China."), [Ke Peng](https://pubmed.ncbi.nlm.nih.gov/?term=Peng+K&cauthor_id=42745683)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42745683/#short-view-affiliation-1 "Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42745683/#short-view-affiliation-2 "Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China."), [Hong Liu](https://pubmed.ncbi.nlm.nih.gov/?term=Liu+H&cauthor_id=42745683)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42745683/#short-view-affiliation-4 "Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA, USA."), [Fuhai Ji](https://pubmed.ncbi.nlm.nih.gov/?term=Ji+F&cauthor_id=42745683)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42745683/#short-view-affiliation-1 "Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42745683/#short-view-affiliation-2 "Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China."), [Xisheng Shan](https://pubmed.ncbi.nlm.nih.gov/?term=Shan+X&cauthor_id=42745683)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42745683/#short-view-affiliation-1 "Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42745683/#short-view-affiliation-2 "Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China."), [Yulan Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+Y&cauthor_id=42745683)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42745683/#short-view-affiliation-1 "Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42745683/#short-view-affiliation-2 "Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China.") ### Affiliations * 1 Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China. * 2 Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China. * 3 Department of Anesthesiology, The Fifth People's Hospital of Huai'an, Huai'an, Jiangsu, China. * 4 Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA, USA. * PMID: **42745683** * DOI: [ 10.1080/07853890.2026.2732555 ](https://doi.org/10.1080/07853890.2026.2732555) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background:** Whether ephedrine, when used to maintain intraoperative blood pressure, is superior to phenylephrine in reducing postoperative delirium remains uncertain. This study aims to determine whether the intraoperative management of hypotension with ephedrine, compared with phenylephrine, reduces the incidence of postoperative delirium in elderly patients undergoing major non-cardiac, non-neurosurgical surgery. **Methods:** This multicentre, randomized, double-blind, controlled trial will enrol 1,084 elderly patients scheduled for elective non-cardiac and non-neurosurgical major surgeries under general anaesthesia at seven hospitals in China. Participants will be randomized in a 1:1 ratio, stratified by study centre, to receive continuous intravenous infusion of either phenylephrine or ephedrine to maintain mean arterial pressure within 20% of the baseline value. The primary outcome is the incidence of postoperative delirium within 7 days after surgery. Secondary outcomes include severity of postoperative delirium, numeric rating scale pain scores at rest and during activity at 24, 48 and 72 h postoperatively, intensive care unit (ICU) admission rate and length of ICU stay, length of postoperative hospital stay, incidence of in-hospital major adverse cardiovascular and cerebrovascular events (myocardial infarction, arrhythmia, heart failure, and stroke), and 30-day all-cause mortality. **Discussion:** We hypothesize that ephedrine, when used to maintain intraoperative blood pressure, is superior to phenylephrine in reducing postoperative delirium in elderly patients undergoing major non-cardiac, non-neurosurgical surgery. The findings of this study may provide high-quality evidence for optimizing the management of intraoperative hypotension in this vulnerable population. **Trial registration:** Chinese Clinical Trial Registry (ChiCTR2500115385). **Keywords:** Postoperative delirium; elderly; ephedrine; general anaesthesia; phenylephrine. 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