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LOW FLOW ANESTHESIA WILL GAIN ERAS (ENHANCED RECOVERY AFTER SURGERY) Senapathi, Tjokorda Gde Agung; Suarjaya, I Putu Pramana; Pradhana, Adinda Putra; Makmur, Eric
Bali Journal of Anesthesiology Vol 1, No 3 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i3.24

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ABSTRACT As we know, the volatile agent needs fresh gas flow to be carried out to the patient. It is very common in anesthesia practice, we use the fresh gas flow more than 2 liters per minute. In recent practice, the more flow we gave, the more volatile agent blew out to the patient. The present of APL (adjustable pressure limit) also leaks out of the circuit, we spend more gases, volatile agent, hence gave more pollutant to the operating theater. The consequences of those are an increase of anesthesia expenses and change the way of health care being delivered.ERAS (Enhanced Recovery After Surgery) is popular with its quick recovery after surgery, include quick emergence post anesthesia, that will reduce the time in the operating theater, recovery room, and as results, reduce the cost of anesthesia and surgery. 
EXTENDED GLASGOW OUTCOME SCALE AND CORRELATION WITH BISPECTRAL INDEX Senapathi, Tjokorda Gde Agung; Suarjaya, I Putu Pramana; Sutawan, Ida Bagus Krisna Jaya; Arparitna, Ketut Yudi
Bali Journal of Anesthesiology Vol 1, No 3 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i3.9

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Traumatic brain injury (TBI) is a major public health issue, which results in significant mortality and long-term disability. The profound impact of TBI is not only felt by the individuals who suffer the injury but also their caregivers and society as a whole. Clinicians and researchers require reliable and valid measures of long-term outcome not only to truly quantify the burden of TBI and the scale of functional impairment in survivors but also to allow early appropriate allocation of rehabilitation supports. In addition, clinical trials which aim to improve outcomes in this devastating condition require high-quality measures to accurately assess the impact of the interventions being studied. In this article, we review the properties of an ideal measure of outcome in the TBI population. Then, we will describe the measurement tools include: the Glasgow Outcome Scale (GOS) and extended Glasgow Outcome Scale (GOSe) in correlation with bispectral index (BIS).
Anaesthesia Management of Patient at 16 Weeks Pregnancy with Primary Malignant Bone Tumour Underwent Hemipelvectomy Surgery Sinardja, Cynthia Dewi; Senapathi, Tjokorda Gde Agung; Suarjaya, I Putu Pramana; Suranadi, I Wayan; Kusuma, Oscar Indra; D.H., Asterina
Bali Journal of Anesthesiology Vol 2, No 2 (2018)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v2i2.39

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Chondrosarcoma is a type of sarcoma that affects the bones and joints. It is a rare cancer that accounts for about 20% of bone tumours and is diagnosed in approximately 600 patients each year in the United States. Chondrosarcoma typically affects adults between the age of 20 and 60 years old. The disease usually starts in the bones of the arms, legs or pelvis, but it can be found in any part of the body that contains cartilage. Sometimes chondrosarcoma grows on an otherwise healthy bone or it grows on a benign bone tumour (an enchondroma or osteochondroma). Non-obstetric surgery during pregnancy is not uncommon and can have excellent outcomes with proper planning. Between 0.75% and 2% of pregnant women require non-obstetric surgery. Surgery can be required during any stage of pregnancy depending on the urgency of the indication. When caring for pregnant women undergoing non-obstetric surgery, safe anaesthesia must be provided for both the mother and the child. Thorough understanding of the physiological and pharmacological adaptations to pregnancy is required to ensure maternal safety. Fetal safety requires avoidance of potentially dangerous drugs at critical times during fetal development, assurance of continuation of adequate uteroplacental perfusion, and avoidance and/or treatment of preterm labour and delivery.Pregnant patients beyond 18–20 weeks of gestation should be positioned with a 15° left lateral tilt, to reduce aortocaval compression and supine hypotension syndrome. Regional anaesthesia with combined spinal epidural is an option for this case. Regional anaesthesia does reduce the exposure of foetus to potential teratogens, avoids the potential risk of failed intubation and aspiration, and provides excellent post-operative analgesia. The major concern with neuraxial anaesthesia is maternal hypotension, which may reduce placental perfusion.  During anaesthesia and surgery, foetal well-being is best ensured by careful maintenance of stable maternal haemodynamic parameters and oxygenation. Close monitoring of foetal responses for signs of distress is strongly advocated.
Supraspinal Modulation : Something to be Remembered Suarjaya, I Putu Pramana; Lolobali, Marilaeta Cindryani; Parami, Pontisomaya; Senapathi, Tjokorda Gde Agung
Bali Journal of Anesthesiology Vol 2, No 2 (2018)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v2i2.57

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Pain had always been a challenging issue in patients with acute and chronic condition.  Pain results from activation of sensory receptors specialized to detect actual or impending tissue damage. However, a direct correlation between activation and nociceptors and the sensory experience of pain is not always apparent. Emotional state, the degree of anxiety, attention and distraction, past experiences, memories, and many other factors can either enhance or diminish the pain experience.Many active agents are used to block and alleviate pain sensation in acute and chronic settings. When an inadequate treatment for acute pain and neuralgia occurred, it would induce complex processes involving both central and peripheral sensitization contributing to persistent post-surgical pain and worsening neuralgia that would lead to chronic pain issue.The important thing to be considered is that this pain process is an intertwined and interconnecting and sustainable process that could not be cut abruptly. Our aim is to remind us to accept that pain pathway is merely not one straight way but still a convoluting idea which could still revolve and expand. Imagining areas could be defined surely one day through high technology advances and would lead us into defining the depth of this beautiful yet complex pathway.
CASE REPORT ANESTHETIC MANAGEMENT OF ADRENAL TUMOR RESECTION Widnyana, I Made Gede; Putra, Kadek Agus Heryana; Kurniyanta, Putu; Suarjaya, I Putu Pramana; Suranadi, I Wayan; Hartono, Budi
Bali Journal of Anesthesiology Vol 2, No 2 (2018)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v2i2.28

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ABSTRACTThe adrenal glands are secretory organs that are located above each kidney and produce hormones that play a major role in the metabolic processes. Tumors of the adrenal gland can cause metabolic abnormalities associated with hormonal disorders such as Cushings syndrome, pheochromocytoma, or Conns syndrome. To be able to give a good anesthetic management on resection of the adrenal tumor, it requires adequate preoperative evaluation. However, this will take large resources. Management of anesthesia in adrenal tumor with an unknown hormonal disorder should consider a variety of hormonal abnormalities that may present in the patient so it can be anticipated effectively.Keywords: incidentaloma, adrenalectomy, hormonal disorder, perioperative
Penatalaksanaan Anestesi pada Pasien Cedera Kepala Berat akibat Hematoma Epidural Akut disertai Kehamilan Aulyan Syah, Bau Indah; Suarjaya, I Putu Pramana; Rahardjo, Sri; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 6, No 3 (2017)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v6i3.54

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Penanganan cedera kepala berat selalu bertujuan untuk mempertahankan tekanan perfusi otak (TPO) dan mencegah peningkatan tekanan intrakranial yang dapat menyebabkan cedera otak sekunder. Pada pasien dengan kehamilan, janin juga harus dipantau. Hiperventilasi harus dihindari karena berefek buruk terhadap perfusi otak dan aliran darah plasenta. Seorang wanita, 25 tahun, 60 kg, 160 cm datang ke rumah sakit akibat trauma kepala karena kecelakaan lalu lintas yang dialami kurang dari 1 jam sebelum masuk rumah sakit dengan GCS E4M6V4. Pasien dalam keadaan hamil G1P0A0 dengan usia kehamilan 28–30 minggu. Di unit gawat darurat terjadi penurunan kesadaran mendadak hingga GCS E1M5V1 sehingga dilakukan intubasi endotrakhea disusul dengan pemeriksaan CT Scan dengan hasil hematoma epidural dekstra dan hematoma subarachnoid disertai midline shift. Pasien kemudian menjalani operasi evakuasi hematoma epidural dengan anestesi umum kemudian di rawat di unit perawatan intensif dengan pipa endotrakhea masih dipertahankan. Denyut jantung janin (DJJ) masih terdengar dan dilakukan observasi ketat DJJ selama perawatan di ICU. Namun setelah beberapa hari di ICU, janin dinyatakan meninggal. Ringkasan: Pasien cedera kepala berat dengan hematoma epidural dan subarachnoid disertai kehamilan telah menjalani operasi anestesi umum dengan tetap memperhatikan pemeliharaan tekanan perfusi otak (TPO) dan mempertahankan kondisi janin dalam batas normal. Meskipun pada akhirnya janin tidak bisa diselamatkan akibat lamanya perawatan ibu dengan ventilator.Anesthesia Management for Patients in Pregnancy with Severe Head Injury Due to Acute Epidural Hematoma Management of severe head injury cases, in any given situation, is targeted to maintain cerebral perfusion pressure (CPP), and preventing increase of intracranial pressure that possibly cause secondary brain injury. In a case of pregnancy, besides considering the maternal status, fetus condition is equally important to observe. Hyperventilation should be avoided due to its possible detrimental effect to both the brain perfusion and placental blood flow. A 25 year old female, 60 kg, 160 cm, was taken to the hospital due to head trauma caused by a traffic accident, roughly about an hour prior to hospitalization. GCS was E4M6V4. The patient was in her 28 – 30 week of pregnancy (G1P0A0). Sudden decrease in consciousness occurred and GCS lowered to E1M5V1. Endotracheal intubation was then prompted. Epidural haematoma subarachnoid haematoma with midline shift revealed in CT scan. The patient underwent epidural hematoma evacuation with general anesthesia then transferred to Intensive Care Unit (ICU) with ETT maintained. Fetal heart rate remains heard, followed with close monitoring of the fetal heart rate during treatment in the ICU. After 3 days in ICU, fetus died. Summary: A pregnant patient with severe head injury of epidural and subarachnoid bleeding, has undergone an operation with general anesthesia. The fetus was unfortunately cannot be saved due to the patient long ventilator treatment.
Konsep Dasar Target Controlled Infusion (TCI) Propofol dan Penggunaannya pada Neuroanestesi Krisna J. Sutawan, Ida Bagus; Suarjaya, I Putu Pramana; Saleh, Siti Chasnak; Wargahadibrata, A. Hmendra
Jurnal Neuroanestesi Indonesia Vol 6, No 1 (2017)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v6i1.40

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Semakin banyaknya dokter anestesi yang cendrung memilih total intravenous anesthesia (TIVA) terutama untuk operasi bedah saraf, merangsang munculnya sebuah penemuan baru yang dapat menghitung dan memperkirakan kadar obat anestesi di dalam plasma dan target organ yang selanjutnya dikenal dengan Target-controlled Infusion (TCI). Jika obat yang digunakan adalah propofol maka dikenal dengan TCI propofol. Ada dua model yang saat ini tersedia secara komersial untuk TCI propofol yaitu model Marsh dan model Schnider. Untuk dapat dengan baik menggunakan kedua model tersebut diperlukan pengetahuan yang mendalam mengenai konsep farmakokinetik tiga kompartemen dan farmakodinamik yang menjadi dasar dalam penghitungan dosis propofol pada kedua model tersebut. Jika menggunakan model Marsh maka disarankan untuk menggunakan target plasma, sedangkan  pada model Schneider sebaiknya digunakan target effect. TCI propofol yang digunakan dengan baik dapat memberikan keadaan anestesi yang hemodinamiknya relatif stabil pada saat induksi dan pemeliharaan, penurunan angka penekanan respirasi, dan peningkatan waktu pemulihan. Basic Consept on Targeted-controlled Infusion (TCI) Propofol and its use in NeuroanesthesiaThere is increasing number of anesthesiologist who prefer to use total intravenous anesthesia especially neurosurgery, stimulate new invention that can calculate and predict drug concentration in plasma and target organ, that have known as Target-Controlled Infusion (TCI). If propofol is used, it is known as TCI propofol. There are two kind of TCI propofol modes that provided commercially, that are Marsh mode and Schnider mode. Understanding the different between those two modes needs knowleadge about pharmacokinetic of the three compartement models and pharmacodynamic which is the base of the calculation of the propofol dose. If Marsh mode is used, than it is suggested to use it in plasma target, however if the Schnider mode is used, than it is suggested to use it in target effect. TCI propofol, which is used in good manner can provide an anesthesia with relatifly stable haemodinamic on induction and maintenance, decrease respiratory depression and increase recovery time.
Tatalaksana Anestesi pada Prosedur Minimal Invasive Neurosurgery: Kasus Perdarahan Intraserebral Traumatika Laksono, Buyung Hartiyo; Suarjaya, I Putu Pramana; Rahardjo, Sri; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 5, No 2 (2016)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v5i2.68

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Traumatic brain injury (TBI) menyumbang 70% kematian akibat trauma. Penyebab yang tersering adalah kecelakaan lalu lintas 49%. Tehnik minimal invasif cukup berkembang pada beberapa dekade ini, demikian juga pada bidang bedah saraf. Tujuan utama tatalaksana anestesia adalah immobilisasi intraoperatif, stabilitas kardiovaskuler, minimal komplikasi pascaoperasi, fasilitasi intraoperatif neurologi monitoring, kolaborasi tatalaksana peningkatan tekanan intrakranial (TIK) dan rapid emergence untuk pemeriksaan neurologis dini. Kasus laki-laki 50 tahun dengan perdarahan intraserebral (ICH) direncanakan operasi minimal invasive neuroendoscopy evakuasi hematom. Posisi selama operasi adalah true lateral yang juga menjadi perhatian tersendiri. Komplikasi akibat posisi harus dihindari karena rentan mempengaruhi luaran operasi. Operasi berjalan selama 3 jam dengan luaran optimal. Beberapa masalah penting menjadi perhatian khusus selama operasi dan pascaoperasi. Prinsip tatalaksana anestesi pada minimal invasif yang harus dicapai adalah pemeriksaan dan perencanaan preoperatif yang baik, kontrol hemodinamik serebral untuk menjamin tekanan perfusi otak (cerebral perfusion presure/CPP) optimal, immobilisasi penuh, dan dapat dilakukan rapid emergence untuk menilai status neurologis. Komunikasi antara operator dan ahli anestesi penting untuk keberhasilan kasus ini.Anesthesia Management in Minimally Invasive Neurosurgery Procedure: Traumatic Intracerebral Hemorrhage CaseTraumatic brain injury (TBI) accounted for 70% of deaths from trauma. The most common causes of traffic accidents is 49%. Minimally invasive techniques sufficiently developed in the past few decades, as well as in the field of neurosurgery. The main objective is the treatment of immobilization intraoperative anesthesia, cardiovascular stability, minimal postoperative complications, facilitating intraoperative neurological monitoring, collaborative management of an increase in intracranial pressure (ICP) and the rapid emergence of early neurological examination. The case of a man 50 years with intracerebral hemorrhage (ICH) minimally invasive surgery neuroendoscopy planned evacuation of hematoma. Position during operation is true lateral is also a concern in itself. Complications due to the position should be avoided because it is vulnerable affect the outcome of the operation. Operations run for 3 hours with optimal outcomes. Some important issue is of particular concern during surgery and postoperatively. Procedural principle in minimally invasive anesthesia to be achieved is the examination and good preoperative planning, cerebral hemodynamic control to ensure optimal cerebral perfussion pressure (CPP), full immobilization, and can do rapid emergence to assess the neurological status. Communication between the operator and the anesthetist is important to the success of this case.
Penggunaan Dexmedetomidin untuk Operasi Meningioma Petroclival dengan Intraoperatif Neurophysiological Monitoring Permatasari, Endah; Suarjaya, I Putu Pramana; Saleh, Siti Chasnak; Wargahadibrata, A Himendra
Jurnal Neuroanestesi Indonesia Vol 6, No 1 (2017)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v6i1.35

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Dexmedetomidin merupakan obat baru yang popular dalam neuroanesthesia dan neurocritical care. Tumor supratentorial yang tersering ditemui pada orang dewasa adalah glioma, meningioma dan adenoma hipofisis. Penggunaan intraoperative neurophysiological monitoring (IOM) dapat mengurangi risiko defisit neurologis pascaoperasi. Penggunaan IOM memiliki kelebihan karena dapat mendeteksi lebih dini kelainan saraf yang mungkin akan terjadi. Seorang pasien, wanita 45 tahun dengan berat badan 60 kg dengan diagnosis meningioma petroclival kiri. Pasien dilakukan operasi kraniotomi pengeluaran tumor. Selama operasi digunakan pemeliharaan obat dexmedetomidin dan propofol.Dilakukan pemantauan menggunakan IOM. Pembiusan dan operasi berlangsung selama 5 jam. Pasien langsung dibangunkan pascaoperasi dan dirawat di ICU. Anestesi untuk operasi tumor meningioma petroclival dengan pemantauan IOM membutuhkan suatu pemahaman mengenai patofisologi otak, pengaturan dan pemeliharaan perfusi otak serta menghindari komplikasi sistemik akibat cedera otak yang terjadi. Penggunaan IOM memperbaiki luaran pasien karena dapat mendeteksi lebih dini defisit neurologis sehingga intervensi dapat dilakukan lebih awal. Pemilihan obat-obat anestesi yang tepat menjadi kunci manajemen anestesi pelaksanaan kasus ini.Dibutuhkan komunikasi yang erat antara neurofisiologist, dokter anestesi dan ahli bedah untuk interpretasi IOM.The use of Dexmedetomidine for Craniotomy Meningioma Petroclival Tumor Removal with Intraoperative Neurophysiological MonitoringDexmedetomidine is a new drug gaining popularity in neuroanestesthesia and neurocritical care practice. The most common supratentorial tumor found in adults are gliomas, meningiomas and pituitary adenomas. The use of intraoperative neurophysiological monitoring (IOM) can reduce the risk of postoperative neurological deficits. Use of IOM has the advantage of early detection of neurological disorders that might happen. A patient, a 45-year-old woman with a body weight of 60 kgs and diagnosed with left meningioma petroclival. Patient is carried out a surgery craniotomy for tumor removal. During the procedure dexmedetomidine and propofol are used. The procedure lasts for 5 hours. Patient was awakened immediately postoperatively for further monitoring in the ICU. The use of IOM in craniotomy petroclival meningiomatumor removal requires an understanding of the brain patophysiology, maintenance of cerebral perfusion pressure and avoiding systemic complications of brain injury that might occur. Use of IOM may improve patient outcomes as it can detect neurological deficits more quickly so that intervention can occur earlier. Selection of the appropriate anesthetic drugs is the key implementation anesthetic management of this case. A close working working relationship of the monitoring team, the anesthesiologist, and the surgeon is the key to the successful conduct and interpretation of IOM.
Penatalaksanaan Perioperatif pada Bedah Dekompresi Mikrovaskular: Sajian Kasus Serial Rahardjo, Sri; Firdaus, Riyadh; Suarjaya, I Putu Pramana
Jurnal Neuroanestesi Indonesia Vol 5, No 1 (2016)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Dekompresi mikrovaskular (microvascular decompression/MVD) adalah terapi definitif dari spasme hemifasial, yakni suatu gangguan gerakan neuromuskular wajah. Spasme ini ditandai dengan kontraksi involunter berulang pada otat yang diinervasi oleh N. fasialis (N.VII) akibat penekanan oleh arteri, tumor atau kelainan vaskular lainnya. Prevalensinya mencapai 9–11 kasus per 100.000 populasi sehat, dan paling sering terjadi pada usia 40–60 tahun. Meskipun bukaan operasi MVD kecil yaitu di sekitar retroaurikula tetapi teknik anestesi-nya menggunakan prinsip-prinsip pembedahan fossa posterior. Bukaan lapangan operasi yang baik, kewaspadaan terhadap rangsangan ke batang otak maupun nervus kranialis dan kewaspadaan terhadap penurunan perfusi otak merupakan pilar-pilar utama tatalaksana anestesia pada MVD. Disajikan empat kasus spasme hemifasial dengan keadaan khusus. Kasus pertama operasi dilakukan pada pasien geriatri, pasien kedua dengan riwayat hipertensi, pasien ketiga dengan leher pendek dan asma, pasien terakhir dengan diabetes mellitus serta hipertensi. Pemantauan kestabilan hemodinamik, kedalaman anestesia dan relaksasi otot merupakan aspek penting yang menyertai tata laksana anestesi pada kasus ini.Perioperative Management in Microvascular Decompression Surgery: Case Series ReportMicrovascular decompression (MVD) is the definitive surgery for hemifacial spasm. The symptoms is described as a repetitive involuntary muscle contraction which innervated by N.fascialis caused by compression of the nervus by enlarged artery, tumor or vascular malformation. Its happened to 9-11 people from 100.000 population, especially in 4th to 6th decades. Although MVD operation only need small opening in retroauricula area but it still use posterior fossa operation principles. They are sufficient work field, awareness of impulse to brain stem and cranial nerves, and decrease of cerebral perfusion pressure. We present four cases of hemifacial spasm, with variety of considerations. The first case was a geriatric patient, the second was with history of hypertension, the third patient has short neck and also history of hypetension and asthma and the last is with diabetes mellitus and history of hypertension. Hemodynamic monitoring, deepness of anesthesia and adequate muscle relaxation is important parameter of anasthetical management of these cases.
Co-Authors A Himendra Wargahadibrata A Himendra Wargahadibrata A. Himendra Wargahadibrata A. Himendra Wargahadibrata A. Himendra Wargahadibrata A. Himendra Wargahadibrata Adinda Putra Pradhana Andika Metrisiawan Aulyan Syah, Bau Indah Bagus Paramartha Bau Indah Aulyan Syah Brillyan Jehosua Toar Budi Santo Chau Febriani Kharisma Christanto, Sandhi Cynthia Dewi Sinardja D.H., Asterina Damayanti, Elok Demoina, I Gede Patria Dewa Ayu Mas Shintya Dewi Endah Permatasari Eric Makmur, Eric Fajar Narakusuma Firdaus, Riyadh Garry D. Chrysogonus Kumaat Gd. Harry Kurnia Prawedana Hendrikus Gede Surya Adhi Putra Hengky Hengky I Gusti Agung Gede Utara Hartawan I Ketut Sinardja I Ketut Sinardja I Ketut Sinardja I Made Gede Widnyana I Nyoman Novi Supradnyana I Putu Agus Surya Panji I Wayan Ade Punarbawa I Wayan Suranadi I. D. G. Tresna Rismantara Ida Bagus Alit Saputra Ida Bagus Krisna J Sutawan Ida Bagus Krisna Jaya Sutawan Ida Bagus Krisna Jaya Sutawan Jancolin Yani Yani Kadek Agus Heryana Putra, Kadek Agus Ketut Yudi Arparitna, Ketut Yudi Kevin Paul Johanes Kurniawan Komala, Tomas Ari Kusuma, Oscar Indra Laksono, Buyung Hartiyo Made Wiryana Madyline Victorya Katipana Marilaeta Cindryani Lolobali, Marilaeta Cindryani Michael Christopher Muhammad Aris Sugiharso Ni Made Supradnyawati Ni Made Supradnyawati, Ni Made Ni Putu Wardani Nova Juwita Permatasari, Endah Pontisomaya Parami Putu Kurniyanta Riyadh Firdaus Saleh, Siti Chasnak Sandhi Christanto Siti Chasnak Saleh Siti Chasnak Saleh Siti Chasnak Saleh Sri Rahardjo Sri Rahardjo Sri Rahardjo Sri Rahardjo Sri Rahardjo Steven Okta Chandra Tatang Bisri Tatang Bisri Tatang Bisri Tjokorda Gde Agung Senapathi Tomas Ari Kurniawan Komala Wargahadibrata, A. Hmendra Win Muliadi Win Mulyadi