[A change in substitution therapy in patients with congenital adrenogenital syndrome within the scope of surgical interventions].

Stress response during genital surgery was investigated in 18 female patients with CAH. Changes were studied in blood pH and base excess, in serum concentrations of sodium- and potassium ions, in concentrations of 17 OHP in serum and saliva. The following conclusions may be drawn: On the day of operation patients should receive 100 mg Prednisolut per square metre of body surface area i.v., divided in three doses. On postoperative days 1 and 2 the 4 to 6 fold, on postoperative days 3 and 4 the 2 to 3 fold amounts of supplementary doses of hydrocortisone should be administered. Fludrocortisone is substituted with 3-5 mg DCA i.m. only on the day of operation. It is convenient to use a half-isotonic solution of electrolytes with 5% glucose for the infusion therapy. A dose of 25-50 mg Prednisolut i.v. can be added to the substitution therapy before short diagnostic and therapeutic procedures with or without anaesthesia such as endoscopy or change of bandage. Radenarcon (etomidate), used for induction of anesthesia, is contraindicated in patients with CAH.