We read with a great interest the multicenter retrospective cohort study by Ma et al.1  demonstrating higher odds of developing postoperative delirium with phenylephrine use in comparison to ephedrine for the management of intraoperative hypotension. Additionally, a dose-dependent effect of phenylephrine on the delirium following surgery under general anesthesia was observed, making authors to suggest that using ephedrine over phenylephrine for intraoperative hypotension may be useful in reducing the risk of postoperative delirium.

We acknowledge that the conclusions from the study are based on well-conducted logistic and fractional polynomial regression analysis adjusted for a priori defined confounding variables including length of surgery and duration of intraoperative hypotension. Despite this, we believe that there exist clear clinical concerns that need attention.

First, there exists variability in vasopressor choice across individual anesthesia providers, which is usually guided by the severity and frequency of hypotensive episodes during surgery as well as by...

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