Only few descriptions of intraoperative carcinoid syndrome (ioCS) have been reported. The primary objective of this study was to describe ioCS. A second aim was to identify risk factors of ioCS. We retrospectively analysed patients operated for small-bowel neuroendocrine tumour in our institution between 2007 and 2015, and receiving our preventive local regimen of octreotide continuous administration. ioCS was defined as highly probable in case of rapid (<5 min) arterial blood pressure changes ≥40%, not explained by surgical/anaesthetic management and regressive ≥20% after octreotide bolus injection. Probable cases were ioCS which did not meet all criteria of highly-probable ioCS. Suspected ioCS were detected on the anaesthesia record by an injection of octreotide due to a manifestation which did not meet the criteria for highly-probable or probable ioCS. A total of 81 patients (liver metastases: 59, prior carcinoid syndrome: 49, carcinoid heart disease: 7) were included; 139 ioCS occurred in 45 patients: 45 highly probable, 67 probable and 27 suspected. ioCs was hypertensive (91%) and/or hypotensive (29%). There was no factor, including the use of vasopressors, significantly associated with the occurrence of an ioCS. All surgeries were completed and one patient died from cardiac failure 4 days after surgery. After preoperative octreotide continuous infusion, ioCS were mainly hypertensive. No ioCS risk factors, including vasopressor use, were identified. No intraoperative carcinoid crisis occurred, suggesting the clinical relevance of a standardized octreotide prophylaxis protocol.

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RésuméObjectif La prise en charge des intoxications a`l'ace´taminophe`ne est centre´e sur le risque d'insuffisance he´patique. Or la survenue d'une insuffisance re´nale aigue¨, bien que plus rare, peut entraıˆner des complications me´t-aboliques graves, voire ne´cessiter des se´ances d'e´puration extra-re´nale. Nous rapportons trois cas d'insuffisance re´nale apre`s des intoxications a`l'ace´taminophe`ne. É léments cliniques Trois patientes aˆge´es de 17 a`46 ans ayant absorbe´de 19 a`32 g d'ace´taminophe`ne e´taient hospitalise´es a`l'unite´de soins intensifs pour une insuffisance he´patique aigue¨sans ence´phalopathie. Alors que la fonction he´patique s'ame´liorait, une de´gradation de la fonction re´nale survenait a`partir du 4 e`me jour. Quatre se´ances d'e´puration extra-re´nale e´taient ne´cessaires pour une patiente en raison d'une insuffisance re´nale aigue¨anurique. La fonction he´patique s'est ame´liore´e entre le 4 e`me et le 9 e`me jour pour chacun des cas, tandis que l'insuffisance re´nale re´gressait plus tard, apre`s 10 à 20 jours. Le bilan e´tiologique de ces insuffisances re´nales e´tait ne´gatif, faisant suspecter le diagnostic de ne´crose tubulaire toxique a`l'ace´taminophe`ne. Conclusion La physiopathologie de cette ne´crose tubulaire aigue¨est encore impre´cise et peu de´crite, ne permettant pas de proposer une strate´gie spe´cifique de prise en charge. Lors de toute intoxication a`l'ace´taminophe`ne, nous sugge´rons de surveiller la cre´atinine se´rique jusqu'au septie`me jour, quelle que soit la gravite´d e l'atteinte he´patique et la quantite´d'ace´taminophe`ne inge´re´e. AbstractPurpose Management of acetaminophen overdose focuses on the risk hepatic failure. However, acute renal failure, although less frequent, can lead to serious metabolic complications and require hemodialysis. We report three cases of acute renal failure related to acetaminophen overdose. Clinical features Three patients, aged 17-46 yr ingested acetaminophen 19 to 32 g, and were admitted to the intensive care unit because of acute liver failure without hepatic coma. While liver function improved, each patient developed acute renal failure starting on the fourth day. Four sessions of hemodialysis were required in one patient because of anuria. Hepatic function improved from the fourth to the ninth day in each case, whereas renal function recovered later, 10-20 days after ingestion. Investigations were negative for other causes of renal failure, and acute tubular necrosis due to acetaminophen was suspected. Conclusion The pathophysiology of this type of acute tubular necrosis remains unclear and thus, there is no specific treatment. Nevertheless, in all cases of acetaminophen overdose, we suggest following serum creatinine levels during the first week, regardless of the degree hepatic failure or quantity of acetaminophen ingested.Les intoxications à l'acétaminophène sont responsables d'hépatites aiguës pouvant évoluer vers une insuffisance hépatique aiguë (IHA), voire une hépatite fulminante.

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