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[Metformin and surgery before general anaesthesia].

Elisabeth Lauritzen1, David Hebbelstrup Jensen, Christian Bonde

  • 1elisabethlauritzen@hotmail.com.

Ugeskrift for Laeger
|January 9, 2019
PubMed
Summary

Metformin does not increase the risk of lactic acidosis in patients undergoing surgery. However, comorbidities necessitate careful monitoring of arterial pH and lactate levels, with updated guidelines suggesting discontinuation on the day of surgery.

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Area of Science:

  • Anesthesiology
  • Endocrinology
  • Pharmacology

Background:

  • Danish national guidelines recommend stopping metformin 48 hours before anesthesia due to lactic acidosis concerns.
  • Recent studies suggest metformin does not elevate lactic acidosis risk.

Purpose of the Study:

  • To review the risk of metformin-associated lactic acidosis.
  • To inform updated guidelines on perioperative metformin management.

Main Methods:

  • Literature review of studies on metformin and lactic acidosis.
  • Analysis of risk factors for metformin-associated lactic acidosis.

Main Results:

  • Evidence indicates metformin does not increase lactic acidosis risk.
  • Cardiovascular insufficiency, sepsis, dehydration, and renal impairment are key risk factors.

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  • New guidelines suggest metformin discontinuation on the day of surgery.

    • Conclusions:

    • Metformin discontinuation 48 hours prior to surgery is not supported by current evidence.
    • Patients with Type 2 diabetes and comorbidities require monitoring of arterial pH and lactate.
    • Perioperative management should consider individual patient risk factors.