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Jurnal Neuroanestesi Indonesia

jni
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Published by Indonesian Society of Neuroanesthesia & Critical Care

ISSN : 20889674 EISSN : 24602302 DOI : https://doi.org/10.24244/jni

Core Subject : Health, Science, Education,

Biochemistry, Genetics & Molecular Biology Education Medicine & Pharmacology Neuroscience Public Health

Editor of the magazine Journal of Neuroanestesi Indonesia receives neuroscientific articles in the form of research reports, case reports, literature review, either clinically or to the biomolecular level, as well as letters to the editor. Manuscript under consideration that may be uploaded is a full text of article which has not been published in other national magazines. The manuscript which has been published in proceedings of scientific meetings is acceptable with written permission from the organizers. Our motto as written in orphanet: www.orpha.net is that medicine in progress, perhaps new knowledge, every patient is unique, perhaps the diagnostic is wrong, so that by reading JNI we will be faced with appropriate knowledge of the above motto. This journal is published every 4 months with 8-10 articles (February, June, October) by Indonesian Society of Neuroanesthesia & Critical Care (INA-SNACC). INA-SNACC is associtation of Neuroanesthesia Consultant Anesthesiology and Critical Care (SpAnKNA) and trainees who are following the NACC education. After becoming a Specialist Anesthesiology (SpAn), a SpAn will take another (two) years for NACC education and training in addition to learning from teachers in Indonesia KNA trainee receive education of teachers/ experts in the field of NACC from Singapore.

Arjuna Subject : Kedokteran - Anesthesiology and Pain Medicine

Articles 8 Documents

Search results for , issue "Vol 9, No 2 (2020)" : 8 Documents clear

Pertimbangan Etika Klinik dan Medikolegal untuk Pengelolaan Anestesi pada Kasus Cedera Otak Traumatik Ismail, Taufik Suryadi; Kulsum, Kulsum
Jurnal Neuroanestesi Indonesia Vol 9, No 2 (2020)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Cedera Otak Traumatik (COT) merupakan penyebab utama kematian dan kesakitan pada anak-anak dan dewasa muda di seluruh dunia. Dilaporkan sebuah kasus COT pada seorang pasien anak laki-laki berusia 5 tahun yang jatuh dari lantai 2. Pasien didiagnosis dengan cedera kepala berat dengan perdarahan epidural dan subdural dengan level ASA 34. Dilema etis yang dihadapi ahli anestesi adalah tindakan anestesi berisiko tinggi tetapi kemungkinan penyelamatan nyawa tidak berhasil, sehingga apakah masih tetap dilakukan operasi atau hanya diberikan terapi suportif?. Laporan ini membahas tentang pemecahan dilema etik dan medikolegal berdasarkan teori etika klinik. Hasil pertimbangan etika dan medikolegal pada kasus ini dilakukan secara komprehensif dengan menghasilkan keputusan bersama antara tim dokter dengan keluarga pasien. Dengan pemberian informasi yang adekuat mengenai indikasi medik dengan tetap memperhatikan sudut pandang permintaan (keinginan) pasien, kualitas hidup maupun fitur kontekstual maka meskipun pada akhirnya pasien ini tidak berhasil diselamatkan, paling tidak keluarga pasien puas atas pelayanan yang telah diberikan.Clinical Ethics and Medicolegal Considerations for Anesthesia Management in Cases of Traumatic Brain InjuryAbstractTraumatic Brain Injury (COT) is a leading cause of death and illness in children and young adults throughout the world. A case of COT was reported in a 5-year-old boy who fell from the 2nd floor. The patient was diagnosed with a severe head injury with epidural and subdural bleeding with ASA levels 3-4. The ethical dilemma faced by the anesthesiologist is the high-risk anesthetic procedure but the possibility of life saving is unsuccessful, so whether the surgery is still being performed or only given supportive therapy?. This report discusses solving ethics and medicolegal dilemmas based on clinical ethics theory. The results of ethical and medicolegal considerations in this case were carried out comprehensively by producing a joint decision between the team of doctors and the patient's family. By providing adequate information regarding medical indications while still giving attention to the patients' preferences, quality of life and contextual features, even though these patients were ultimately unsuccessful, at least the patient's family was satisfied with the services provided.

Analisis Penambahan Dexmedetomidine pada Operasi Besar Tulang Belakang Elektif di RSUD Dr. Soetomo Rizkiya, Putri; Rehatta, Nancy Margarita; Harijono, Bambang; Herawati, Lilik
Jurnal Neuroanestesi Indonesia Vol 9, No 2 (2020)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Latar Belakang dan Tujuan: Dexmedetomidine (DEX) suatu agonis ?2, telah banyak digunakan untuk mengendalikan respon stress pembedahan melalui penekanan respon simpatis dan endokrin. Studi ini bertujuan untuk menganalisis efek penambahan dexmedetomidine terhadap kadar kortisol, nadi, tekanan arteri rerata, kebutuhan penggunaan fentanyl dan isoflurane pada operasi tulang belakang.Metode: Sebuah studi randomisasi terkontrol tersamar ganda dilakukan pada pasien yang menjalani operasi besar tulang belakang elektif di RSUD Dr. Soetomo, Surabaya. Nadi, tekanan arteri rerata, kebutuhan fentanyl dan isoflurane serta perubahan kadar kortisol pre dan post-operatif dibandingkan antara pasien yang memperoleh dexmedetomidine (DEX) dan placebo (SAL).Hasil: Nadi dan tekanan arteri rerata lebih stabil pada kelompok DEX pada saat intubasi, prone positioning dan insisi. Perubahan kadar kortisol pada kelompok DEX (9,95,2 mcg/dl) lebih rendah dibanding kelompok SAL (11.78.4 mcg/dl) namun tidak berbeda bermakna secara statistik (p=0.88). Penggunaan fentanyl dan isofluran pada kelompok DEX dapat dikurangi masing-masing 50% (p=0,00) dan 30% (p=0,00). Kecepatan pulih sadar kelompok DEX lebih cepat. (p=0,001) Simpulan: Hemodinamik yang stabil, berkurangnya penggunaan opioid dan anestesi inhalasi serta proses pulih sadar yang lebih cepat pada kelompok DEX mendukung penggunaan dexmedetomidine dalam operasi besar tulang belakang.Analysis of Dexmedetomidine Addition in Elective Major Spinal Surgery in RSUD Dr. SoetomoAbstractBackground and Objective: Dexmedetomidine (DEX) an ?2 agonist, is widely used to control stress response during surgery through inhibition of sympathetic and endocrine response. This study aims to analyze the effect of dexmedetomidine addition towards blood cortisol level, pulse rate, mean arterial pressure, and fentanyl and isoflurane use during major spinal surgery.Method: A randomized doubleblind controlled study was conducted on twenty patients undergoing major spinal surgery in RSUD dr. Soetomo, Surabaya. Pulse rate, mean arterial pressure, fentanyl and isoflurane used, and plasma cortisol changes were compared between patients receiving dexmedetomidine (DEX) and placebo (SAL). Results: Pulse rate and mean arterial pressure was more stable in DEX group during intubation, prone positioning and incision. Changes in cortisol level in DEX group (9.95.2 mcg/dl) was lower, but not statistically significant fromSAL group (11.78.4 mcg/dl,p=0.88). Fentanyl and isoflurane use in DEX group was reduced 50% (p=0.00) and 30% (p=0.00) respectively. Recovery time in DEX group was faster (p=0.001).Conclusion: Hemodinamik stability, reduced opioid and inhalational anesthesia use, and faster anesthesia recovery time supports dexmedetomidine as anadjunct in general anesthesia in major spinal surgery.

Kajian Konsep Lund dan Konsep Rosner untuk Tatalaksana Cedera Otak Traumatik Berat Sumardi, Fitri Sepviyanti; Rachman, Iwan Abdul; Rahardjo, Sri
Jurnal Neuroanestesi Indonesia Vol 9, No 2 (2020)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Tatalaksana pasien dengan cedera otak traumatik (COT) berat mengalami perubahan berkesinambungan selama 30 tahun terakhir. Tatalaksana yang diarahkan di unit perawatan intensif (intensive care unit/ICU) mengacu pada tatalaksana klinis sebagai titik akhir terapi utama, bertujuan untuk mempertahankan variabel fisiologis tertentu secara ketat dalam rentang target yang telah ditentukan. Satu alternatif terhadap terapi konvensional ini adalah konsep Lund yang mengutamakan penurunan tekanan mikrovaskular. Konsep Lund termasuk suatu strategi target volume untuk mengendalikan tekanan intrakranial, berasal dari Universitas Lund Swedia, lebih dari 27 tahun yang lalu dan tetap masih kontroversi sampai saat ini. Sejak tahun 1996, American Brain Trauma Foundation dan European Brain Injury Consortium, yang mengacu pada konsep Rosner, telah menerbitkan dan memperbarui panduan untuk tatalaksana cedera otak traumatik. Para ahli sangat menyadari adanya patologi intrakranial multifaktorial yang terlihat pada pasien COT berat dan kompleksitas mekanisme cedera otak sekunder setelah trauma primer, akan menemukan bahwa revisi ini sulit untuk dipahami. Hubungan antara peningkatan tekanan intrakranial (TIK) dan hasil luaran klinis yang lebih buruk sudah terbukti. Menyederhanakan fisiologi otak setelah COT berat ke strategi tatalaksana pasien bedasarkan ambang batas adalah berkaitan erat dengan hubungan interaksi komplek antara: peningkatan TIK, aliran darah otak, dan metabolisme otak.Review of Lund Concept and Rosner Concept for Therapy of Severe Traumatic Brain InjuryAbstractThe management of patients with severe traumatic brain injury (TBI) has undergone continuous changes over the past 30 years. Management directed at the intensive care unit (ICU) refers to clinical management as the main end point of therapy, aiming to maintain certain physiological variables strictly within a predetermined target range. One alternative to this conventional therapy is the Lund concept which prioritizes the reduction of microvascular pressure. The concept of Lund includes a volume target strategy for controlling intracranial pressure, from Lund University in Sweden, more than 27 years ago and remains controversial to date. Since 1996, the American Brain Trauma Foundation and the European Brain Injury Consortium, which refers to the Rosner concept, have published and updated guidelines for the management of traumatic brain injury. Experts are well aware of the multifactorial intracranial pathology seen in severe TBI patients and the complexity of the mechanism of secondary brain injury after primary trauma will find that this revision is difficult to understand. The relationship between increased intracranial pressure (ICP) and worse clinical outcome has been proven. Simplifying the physiology of the brain after severe TBI to the patient's management strategy based on the threshold is closely related to the relationship between complex interactions: increased ICP, cerebral blood flow (CBF), and brain metabolism.

Anestesi Scalp Block dan Occipital Block pada Tindakan External Ventricular Drainage (EVD) pada Kehamilan 32 Minggu Arshad, Muhammad; Bisri, Dewi Yulianti; Rahardjo, Sri
Jurnal Neuroanestesi Indonesia Vol 9, No 2 (2020)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Hidrosefalus adalah pembesaran ventrikel otak sebagai akibat peningkatan jumlah cairan serebrospinal (CSS) yang disebabkan oleh ketidakseimbangan antara produksi, sirkulasi dan absorbsinya. Perkiraan wanita hamil yang dilakukan operasi non obstetric sekitar 12%. Pasien obstetri dengan penyakit bedah saraf selalu dirawat di ICU. Insidensi operasi selama kehamilan dilaporkan 42% prosedur pembedahan terjadi pada trimester pertama, 35% pada trimester kedua, dan 23% pada trimester ketiga. Seorang wanita 35 tahun dengan usia kehamilan 3233 minggu datang ke IGD dengan penurunan kesadaran tanpa riwayat trauma, tidak dijumpai tekanan darah tinggi. Dari pemeriksaan CT-Scan ditemukan adanya hidrosefalus, sehingga dilakukan tindakan external ventricular drainage (EVD). Anestesi untuk pasien dalam keadaan hamil harus mempertimbangkan bayi dalam kandungan sehingga dilakukan pembiusan scalp block dan occipital block. Obat yang digunakan ropivakain HCl 0,375 % (sebanyak 10cc). Setelah operasi pasien dirawat di ruang pemulihan, 2 jam kemudian dirawat di ruang high care unit (HCU). Pencegahan terhadap hipoksia dan hipotensi adalah keharusan, walaupun periode hipoksemia yang pendek masih bisa ditoleransi. Hipoksemia maternal yang berkepanjangan akan menyebabkan vasokonstriksi sirkulasi uteroplasental yang pada akhirnya menurunkan perfusi sehingga menyebabkan hipoksemia, asidosis dan kematian janin.Scalp Block and Occipital Block Anesthesia for External Ventricular Drainage (EVD) in 32-Week PregnancyAbstractHydrocephalus is enlargement of the brain ventricles as a result of an increase in the amount of cerebrospinal fluid (CSS) caused by an imbalance between production, circulation and absorption. Estimates of pregnant women in non-obstetric surgery are around 12%. Obstetric patients with neurosurgery disorders are always treated in the ICU. The incidence of surgery during pregnancy was reported in 42% of surgical procedures occurred in the first trimester, 35% in the second trimester, and 23% in the third trimester. A 35-year-old woman with 32-33 weeks' gestation came to the emergency room with decreased consciousness yet no history of trauma and high blood pressure. Hydrocephalus were found in CT scan, and the external ventricular drainage (EVD) is taken. The patient has intrauterine pregnancy so the anesthesia choice is scalp block and occipital block. Ropivacaine HCl 0.375% (as much 10cc) was used. After surgery the patient was treated in the recovery room for 2 hours, and discharged to the high care unit (HCU) afterwards. Hypoxia and hypotension is a challenge in short periods of hypoxemia that can still be tolerated. Prolonged maternal hypoxemia prevention will cause uteroplacental circulation vasoconstriction which ultimately reduces perfusion, causing foetal hypoxemia, acidosis and death.

Ventilasi Mekanik yang Memanjang pada Pasien Cedera Otak Traumatik Berat dengan Subdural Hematoma Putri, Dini Handayani; Rachman, Iwan Abdul; Rahardjo, Sri
Jurnal Neuroanestesi Indonesia Vol 9, No 2 (2020)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Cedera otak traumatik (COT) adalah suatu proses patologis pada otak yang berasal dari luar tubuh, yang dapat menyebabkan kerusakan permanen atau sementara dari fungsi otak. Salah satu perdarahan otak yang sering menyertai terjadinya COT berat adalah subdural hematoma (SDH). Pasien laki-laki 41 tahun, datang ke rumah sakit dengan penurunan kesadaran GCS E2M2V2 akibat kecelakaan. Pasien dilakukan tatalaksana dan diintubasi di IGD, hasil CT-Scan memperlihatkan SDH, dan edema serebri. Pasien dilakukan evakuasi hematom dengan anestesi umum, diinduksi dengan fentanil 100 ?gr, propofol 20 mg dan atracurium 20 mg intravena. Pemeliharaan dengan sevofluran, propofol kontinyu, fentanil dan atracurium intermiten. Pascaoperasi pasien mengalami ventilator associated pneumonia (VAP), diberikan antibiotik sprektum luas untuk pemulihan paru, pada hari ke 10 pasien dilakukan trakeostomi. Pasien dapat disapih dari ventilator hari ke 21 dengan GCS E4M4Vtrach tanpa kontak, dengan skor GOS (Glasgow Outcome Scale) 3, direncanakan untuk homecare. COT berat membutuhkan tatalaksana pascaoperasi yang lebih kompleks, antisipasi penggunaan ventilasi mekanik yang memanjang, risiko VAP serta pertimbangan pemasangan trakeostomi secara cepat hingga pemberian antibiotik yang adekuat untuk mendapatkan hasil luaran terbaik.Prolonged Mechanical Ventilation in Severe Traumatic Brain Injury Patients with Subdural HematomasAbstractTraumatic brain injury (TBI) is a pathological process in the brain that originates from outside the body, which can lead to permanent or temporary damage to brain function. One of the brain hemorrhages that often accompanies severe TBI is subdural hematoma (SDH). Male patient 41 years old, was admitted to our hospital with decreased of consciusness with GCS E2M2V2 due to a motorcycle accident. The patient was intubated in the emergency room and then performed head CT scan examination which showed SDH and cerebral edema as the result. Patients then underwent hematoma evacuation under general anesthesia, induced with fentanyl 100 g, propofol 20 mg and atracurium 20 mg intravenously. Maintenance of anesthesia with sevoflurane, continuous propofol, fentanyl and intermittent atracurium. Postoperatively the patient experienced ventilator associated pneumonia (VAP) and given broad-spectrum antibiotics for lung recovery, then on the 10th day tracheostomy was performed. Patients can be weaned from the ventilator on day 21st with GCS E4M4Vtrach without contact, with a GOS (Glasgow Outcome Scale) score of 3, and was planned for homecare. Severe TBI requires more complex postoperative management, anticipation of prolonged use of mechanical ventilation, risk of VAP and consideration of rapid tracheostomy installation to adequate antibiotic administration to obtain the best outcome.

Karakteristik Klinis Pasien Trombosis Sinus Venosus Serebral (TSVS) di Ruang Rawat Inap Neurologi Rumah Sakit Hasan Sadikin Bandung Amalia, Lisda
Jurnal Neuroanestesi Indonesia Vol 9, No 2 (2020)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Latar Belakang dan Tujuan: Trombosis sinus venosus serebral (TSVS) merupakan penyakit akibat oklusi struktur vena intrakranial, termasuk sinus serebral, vena korteks, dan bagian proksimal vena jugularis. Keterlambatan diagnosis dan terapi dapat mengakibatkan terjadinya komplikasi seperti infark berdarah bahkan kematian.Tujuan penelitian ini adalah untuk mengetahui karakteristik klinis pasien TSVS yang diagnosisnya telah dikonfirmasi melalui pemeriksaan DSA. Metode: Penelitian ini bersifat deskriptif observasional retrospektif. Pada pasien yang telah didiagnosis TSVS di Bagian Neurologi Rumah Sakit Hasan Sadikin Bandung periode Juni 2015 sampai November 2017.Hasil: Terdapat 33 subjek dengan rentang usia 40-49 tahun (24,2%) dan mayoritas adalah perempuan sebanyak 22 orang (66,7%). Faktor resiko terbanyak adalah infeksi 8 orang (24,2%), dan kondisi protrombotik sebanyak 6 orang (18,2%). Gejala klinis terbanyak adalah nyeri kepala yaitu 27 orang (81,8%). Lokasi sinus yang tersering mengalami trombosis adalah sinus transversus pada 28 orang dengan gejala mayoritas nyeri kepala. Kadar D-Dimer ditemukan meningkat dengan rata-rata 1,21 mg/L.Simpulan: Pasien TSVS terjadi pada perempuan dengan rentang usia dekade pertengahan dan faktor resiko terbanyak adalah infeksi. Nyeri kepala merupakan gejala paling sering. Lokasi trombosis mayoritas terjadi pada sinus transversus dan ditemukan peningkatan D-Dimer.Clinical Characteristics of Cerebral Venous Sinus Thrombosis (CVST) Patients in Neurology Ward Hasan Sadikin General Hospital BandungAbstractBackground and Objective: CVST is an entity caused by intracranial vein, including cerebral sinuses, cortical vein and proximal part of the jugular vein. A delay in diagnosing and treating can result in brain infarct with hemorrhagic transformation, even death. The goal of this study is to learn the clinical characteristics of patients with CVST that had been confirmed by DSA.Method: This was a retrospective observational descriptive study and subjects were hospitalized patients which had been diagnosed CVST in Neurology ward Hasan Sadikin General Hospital from June 2015 to November 2017.Results: there was 33 subjects with most (22 patient/66.7%) being women between 40-49 years old. In this study the most frequently found risk factor was infection in 8 subjects (24.2%), prothrombotic conditions in 6 subjects (18.2%). The clinical manifestations were mainly headache in 27 subjects (81,8%). The sinus most often involved was the transverse sinus (28 subjects) with the clinical manifestation being headache. D-dimer levels were also increased with mean 1.21 mg/dl.Conclusion: CVST patients are mostly in women at the midle age of decade, with infection being the most frequent risk. Headache was the most frequent clinical manifestation. Location of thrombosis were more often found on the transverse sinus and D-Dimer level was increased.

Tatalaksana Pasien Post Ventriculo Peritoneal (VP) Shunt et causa Meningitis disertai Aspirasi Pneumonia dan Gagal Napas di Ruang Rawat Intensif Kurniawan, Arief; Zulfariansyah, Ardi
Jurnal Neuroanestesi Indonesia Vol 9, No 2 (2020)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Ventriculo Peritoneal (VP) Shunt adalah tindakan operasi pemasangan kateter yang menghubungkan ventrikel otak dan rongga peritoneum. Tindakan VP Shunt bertujuan menurunkan tekanan intrakranial yang tinggi pada hidrosefalus. Pasien hidrosefalus akibat meningitis sering mengalami gagal napas akibat gangguan otak atau aspirasi pneumonia. Terapi ventilasi mekanik diperlukan sebelum, selama dan setelah operasi VP Shunt. Laporan kasus laki-laki 21 tahun datang ke rumah sakit karena gangguan kesadaran dan didiagnosis dengan meningitis. Pasien mengalami gagal napas akibat aspirasi pneumonia dan mendapat terapi ventilasi mekanik, kemudian menjalani operasi VP Shunt atas indikasi hidrosefalus komunikan. Induksi anestesi menggunakan fentanil dan propofol, pemeliharaan anestesi menggunakan sevofluran dan analgesi pascabedah menggunakan fentanil kontinyu. Berdasarkan pemeriksaan cairan serebrospinal pasien didiagnosis meningitis serosa akibat Tuberkulosis. Pasien mendapat terapi antibiotik empirik untuk aspirasi pneumonia dan antituberkulosis. Setelah kesadaran membaik dan weaning ventilator pasien dipindahkan dari ruang perawatan intensif.Management Patient Post Ventriculo Peritoneal (VP) shunt et causa Meningitis with Pneumonia Aspiration and Respiratory Failure in ICUAbstractVentriculo Peritoneal (VP) Shunt is a surgery that connects the brain ventricles and the peritoneal cavity with a catheter. VP Shunt aims to reduce high intracranial pressure in hydrocephalus. Hydrocephalus patients due to meningitis often experience respiratory failure from brain disorder or pneumonia aspiration. Mechanical ventilation therapy is needed before, during and after VP Shunt surgery. Case report of 21-year-old came to the hospital with decreased of conciousness and diagnosed with meningitis. The patient experienced respiratory failure and received mechanical ventilation therapy in the intensive care unit. The patient underwent VP Shunt surgery for indications of communicant hydrocephalus. Induction of anesthesia used fentanyl and propofol, maintenance of anesthesia used sevoflurane and postoperative analgesia used continuous fentanyl. Based on the results of the examination of cerebrospinal fluid, the diagnosis leads to serous meningitis due to Tuberculosis bacteria. Empiric antibiotics therapy for aspiration pneumonia and antituberculosis were given even if no bacteria was found in the blood or cerebrospinal fluid. After improvement in clinical condition and weaning from mechanical ventilator, the patient discharge from the ICU and sent to the ward.

Peran Eritropoietin pada Stroke Iskemik Akut Amalia, Lisda; Saputra, Gilang Nispu
Jurnal Neuroanestesi Indonesia Vol 9, No 2 (2020)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Stroke iskemik merupakan salah satu penyebab stroke tersering, disebabkan oleh oklusi pembuluh darah serebral dan penyebab kematian ketiga. Iskemik otak akan menghasilkan penghasilan mediator inflamasi yang dapat berpartisipasi dalam jejas iskemik di otak. Saat awitan stroke iskemik terjadi, area otak yang diperdarahi oleh pembuluh darah akan kekurangan oksigen dan nutrisi sehingga sel otak terutama neuron berada dalam risiko, neuron ini masih dapat berfungsi yang dikenal sebagai penumbra. Hipoksia jaringan dan iskemik serebral mengaktivasi HIF-1?, yang kemudian mengaktivasi transkripsi gen eritropoietin (EPO) dan Vascular Endothelial Growth Factor (VEGF). Eritropoietin (EPO) merupakan peptida yang juga memiliki efek nonhematopoiesis yaitu berperan mendorong neuroproteksi. Eritropoietin (EPO) dikeluarkan dalam hitungan menit dari proses iskemik dan mencapai puncak dalam 24 jam dari awitan stroke iskemik. Efek neuroproteksi dari EPO yaitu sebagai anti apoptosis, anti oksidan, anti inflamasi, anti eksitoksisitas, neurogenesis, angiogenesis dan neurotropik. Dengan kata lain bahwa EPO dapat mengurangi derajat keparahan akibat oklusi pembuluh darah otak.Role of Eritropoietin in Acute Ischemic StrokeAbstractIschemic stroke is one of the most common causes of stroke, caused by cerebral vascular occlusion and the third cause of death. . Ischemic brain will generate income of inflammatory mediators who can participate in ischemic lesions in the brain. When the recitation of an ischemic stroke occurs, areas of the brain that are obscurated by blood vessels will lack oxygen and nutrients so that brain cells, especially neurons, are at risk, these neurons can still function known as penumbra. Tissue hypoxia and cerebral ischemic activate HIF-1?, which then activates the transcription of the Eritropietin (EPO) and Vascular Endothelial Growth Factor (VEGF) genes. Eritropoietin (EPO) is a peptide that also has the effect of non-hematopoiesis which is responsible for encouraging neuroprotection. Eritropietin (EPO) is issued in minutes of an ischemic process and reaches its peak within 24 hours of the onset ischemic stroke. The neuroprotection effect of EPO is as anti-apoptosis, anti-oxidant, anti-inflammatory, anti-excitation, neurogenesis, angiogenesis and neurotropic. In other words, EPO can reduce the severity due to occlusion of brain blood vessels.

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