Metformin lactic acidosis and anaesthesia: myth or reality?
OBJECTIVE
To determine whether a causal or coincidental relationship is indicated in the literature between metaformin and lactic acidosis and to recommend clinical guidelines for the withdrawal of metformin prior to surgery.


METHODS
A broad review of the literature related to metformin associated acidosis was carried out. (There are few publications specifically related to metformin treatment and anaesthesiology).


RESULTS
When metformin-associated lactic acidosis occurs, a concurrent pathology or contraindication to the use of metformin is often found. Anaesthesia and surgery can generate or aggravate concurrent pathologies.


CONCLUSIONS
Although no association has been shown between metformin and lactic acidosis under usual conditions of use, vigilance is required when metformin is used prior to surgery. The following clinical guideline is proposed: to withdraw (when possible) metformin 48 hours prior to surgery and to wait until the patient's biological and clinical parameters return to normal before reintroducing it.
Vreven
R
R
Department of Anaesthesiology, Cliniques Universitaires Saint Luc, Avenue Hippocrate 10/1821 1200 Brussels. regivreven@hotmail.com
De Kock
M
M
D000140:Acidosis, Lactic / Q000139:chemically induced*; D000758:Anesthesia / Q000009:adverse effects*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D008687:Metformin / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use
D007004:Hypoglycemic Agents; D008687:Metformin