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All Journal Jurnal Anestesiologi Indonesia Jurnal Anestesi Perioperatif Althea Medical Journal Jurnal Anestesi Obstetri Indonesia Jurnal Neuroanestesi Indonesia Jurnal Komplikasi Anestesi

Iwan Abdul Rachman

Department Of Anesthesiology And Intensive Care, Faculty Of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital Bandung

Author-ID : 4172898

Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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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.

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.

Anestesi Posisi Prone untuk Pengangkatan Tumor Torakal Posterior Pasien Pediatri dengan Malnutrisi Kronis dan Gangguan Metabolik Kulsum, Kulsum; Rachman, Iwan Abdul; Prihatno, MM. Rudi; Jasa, Zafrullah Kany
Jurnal Neuroanestesi Indonesia Vol 8, No 3 (2019)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Malnutrisi kronis adalah suatu keadaan dimana tubuh mengalami gangguan dalam penggunaan zat gizi untuk pertumbuhan, perkembangan dan aktivitas. Gangguan metabolik yaitu kondisi adanya kelainan proses metabolisme pada tubuh akibat defisiensi enzim atau hormon. Posisi prone pada neuroanestesi pediatrik tulang belakang dilakukan untuk mencapai tekanan perfusi otak dan tulang belakang yang normal. Tujuan kasus ini membahas pengelolaan neuroanestesi pediatrik pada posisi prone dengan adanya kelainan malnutrisi kronis merupakan hal yang rumit sehingga diperlukan manajemen agar menghasilkan outcome yang baik. Anak laki laki, 8 tahun, 15 kg, 102 cm, benjolan di punggung belakang yang keluar merembes cairan dengan diameter 7 cm sejak lahir, kelemahan anggota gerak, buang air besar dan buang air kecil tertahan. Dilakukan VP-shunt 2 minggu lalu. Premedikasi dengan midazolam dan fentanyl. Induksi menggunakan propofol dan ada penambahan saat laringoskopi dan intubasi. Fasilitas intubasi dengan atracurium. Pemeliharaan anestesi dengan O2 + udara + sevofluran 2% dengan fraksi oksigen 50% + propofol dan rocuronium bolus intravena. Monitoring tanda vital (tekanan darah, denyut jantung, frekuensi nafas, saturasi oksigen, jumlah dan warna urin) serta end tidal CO2. Hasil setelah pengangkatan tumor selama 2 jam hemodinamik relatif stabil, tekanan darah 100120/6080 mmHg. Pasien ditempatkan di Pediatric Intensive Care Unit. Simpulan: diperlukan manajemen neuroanestesi pediatrik untuk menangani kasus malnutrisi kronik dan gangguan metabolik pada pengangkatan tumor torakal posterior agar menghasilkan outcome yang baik.Prone Position Anesthesia for Posterior Thoracal Tumor Removal Pediatric Patient with Chronic Malnutrition and Metabolic DisorderAbstractChronic malnutrition is a condition where the body experiences a disruption in the use of nutrients for growth, development and activity. Metabolic disorders are conditions in which there are abnormal metabolic processes in the body due to enzyme or hormone deficiency. The prone position in pediatric spinal neuroanesthesia is performed to achieve normal cerebral and spinal perfusion pressure. The purpose of this case is to discuss the management of pediatric neuroanesthesia in the complicated prone position in order to produce good outcomes. Boy, 8 years old, 15 kg, 102 cm, a lump in the back that came out seeping fluid with a diameter of 7 cm from birth, weakness in limbs, bowel movements and urinary retention. Performed a VP shunt 2 weeks ago. The premedication method uses midazolam and fentanyl. Induction uses propofol and there are additions during laryngoscopy and intubation. Intubation facilities with atracurium. Maintenance of anesthesia with O2 + air + sevoflurane 2% with 50% oxygen fraction + propofol and intravenous rocuronium bolus. Monitoring vital signs (blood pressure, heart rate, respiratory rate, oxygen saturation, amount and color of urine) and end tidal CO2. Tumor removal results for 2 hours hemodynamically are relatively stable, blood pressure 6080/4050 mmHg. Patients are admit to the Pediatric Intensive Care Unit. Conclusion: pediatric neuroanesthesia management is needed to handle chronic malnutrition and metabolic disorders in the removal of posterior thoracic tumors in order to produce good outcomes.

Penatalaksanaan Anestesi pada Pasien dengan Sindroma Apert yang Dilakukan Suturektomi Rachman, Iwan Abdul; Fuadi, Iwan; Surahman, Eri
Jurnal Neuroanestesi Indonesia Vol 2, No 2 (2013)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Sindroma Apert adalah suatu gangguan genetik yang ditandai dengan penggabungan tulang yang terlalu dini (kraniosinostosis). Penggabungan dini tersebut menghambat pertumbuhan normal tulang dan mempengaruhi pertumbuhan bentuk kepala dan wajah. Penggabungan dini tulang kepala dapat mempengaruhi perkembangan otak bahkan menyebabkan peningkatan tekanan intrakranial, dan pada sindroma Apert juga didapatkan penggabungan beberapa jari tangan dan kaki (sindaktili). Seorang anak berusia 2 tahun dengan sindroma Apert. Tanda klinis peningkatan tekanan intrakranial belum didapatkan sehingga operasi dijadwalkan terencana dan pasien dirawat terlebih dahulu di ruangan. Kemungkinan kesulitan untuk intubasi dengan laringoskopi diantisipasi dengan persiapan intubasi menggunakan optik fiber dan trakeostomi. Pasien diberikan premedikasi midazolam 0,5 mg intravena pada saat pasien akan dibawa ke kamar operasi. Dilakukan anestesi umum, induksi menggunakan propofol 30 mg, fentanil 30 ?g diberikan 3 menit sebelum intubasi. Fasilitas intubasi dengan vekuronium 2 mg, pemeliharaan anestesi dengan N2O/O2 dan Sevofluran. Vekuronium diberikan 1 mg /jam. Ventilasi kendali menggunakan ETT no. 5,0. Operasi berlangsung selama 6 jam dengan posisi pasien terlentang. Hemodinamik selama operasi relatif stabil, tekanan darah sistolik berkisar 90-110 mmHg, tekanan darah diastolik 50-70 mmHg, laju nadi (HR) 87-110 x/mnt, SaO2 99-100 %. Setelah operasi berakhir pasien bernafas spontan adekuat dan dilakukan ekstubasi di kamar operasi. Pasca operasi pasien di rawat di PICU hingga hari ke-4 pasien dipindahkan ke ruangan. Gangguan penggabungan tulang kepala yang terlalu dini dapat menyebabkan gangguan pertumbuhan bentuk kepala, otak dan gangguan pendengaran dan penglihatan. Selain itu juga dapat menyebabkan terjadinya peningkatan tekanan intrakranial. Koreksi segera dengan melakukan suturektomi dan dekompresi dapat mencegah kemungkinan-kemungkinan tersebut.Anaesthetic management of patient with Apert syndrome which undergo suturectomy Apert syndrome is a genetic disorder characterized by the premature fusion of certain skull bones (craniosynostosis). This early fusion prevents the skull from growing normally and affects the shape of the head and face. Early fusion of the skull bones also affects the development of the brain and even can increased the intracranial pressure. In apert syndrome there was also fusion of fingers and toes (syndactyly). A 2 years old child with Apert syndrome which undergo suturectomy and decompression. The clinical signs of raised intracranial pressure in this patient has not been obtained yet so the surgery was done as scheduled . Difficulties to perform intubation with direct laryngoscopy were anticipated through the use of fiber optic and preparation of tracheostomy. Patient has been given premedication using midazolam 0,5 mg given intravenously before his admission to the operating room. The surgery is performed with general anesthesia using propofol 30 mg then fentanyl 30mcg, 3 minutes before intubation. Vecuronium 2mg was given to facilitates intubation. Maintenance of anesthesia with Nitroons/O2 sevoflurane and Vecuronium 1mg/hour. Ventilation was controlled by using ETT no 5.0. Patient was in supine position, and it last for 6 hours. There was relatively stable hemodynamics, systolic blood pressure range 90-110 mmHg, diastolic blood pressure 50-70 mmHg, pulse rate 87-110x/minutes, SaO2 99-100%. After the operation, there was adequate spontaneous breathing so extubation was performed in the operating room, then he was referred to PICU. On day 4 patient was moved to the room. Premature fusion of skull bones will cause growth disorders of the head, brain, and hearing and vision impairment. It also can cause increased intracranial pressure. Immediate correction by suturectomy and decompression can prevent this possibility.

Diagnosis and Management of Cerebral Vasospasm Following Aneurysmal SAH Oktavian, Mirza; Bisri, Dewi Yulianti; Rachman, Iwan Abdul
Jurnal Neuroanestesi Indonesia Vol 14, No 3 (2025)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v14i3.657

Cerebral Vasospasm, characterized by the progressive constriction of cerebral arteries, often occurs following a subarachnoid hemorrhage (SAH) and is a leading cause of morbidity and mortality in affected patients. This condition can be resulted in cerebral ischemia, the severity of which correlates with the degree of vasospasm. The underlying pathophysiology involves the encasement of arteries by blood clots, although the intricate interactions between the hematoma and adjacent structures remain incompletely understood. The delayed onset of vasospasm offers a potential window for preventive interventions. However, recent randomized controlled trials have been discouraging, as they failed to demonstrate any significant improvement in patient outcomes with the use of clazosentan (an endothelin antagonist), simvastatin (a cholesterol-lowering agent), or magnesium sulfate (a vasodilator). Current best practices for managing vasospasm include minimizing ischemia by maintaining adequate blood volume and pressure, administering nimodipine (a calcium channel blocker), and, when necessary, performing balloon angioplasty. Over the past two decades, advancements in the management of vasospasm have significantly reduced associated morbidity and mortality rates. Nevertheless, vasospasm remains a critical determinant of clinical outcomes following aneurysmal rupture.

Terapi Hiperosmolar pada Cedera Otak Traumatika Rachman, Iwan Abdul; Rahardjo, Sri; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 4, No 2 (2015)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Cedera otak traumatika merupakan kasus yang sering ditemukan yang berhubungan dengan morbiditas dan mortalitas yang tinggi. Hipertensi intrakranial dan edema serebral adalah manifestasi utama dari cedera otak berat, keduanya dikenal sebagai kontributor utama pada cedera otak sekunder dan memiliki luaran neurologis yang buruk. Tatalaksana pasien dengan peningkatan tekanan intrakranial dan edema serebral akibat cedera otak traumatika yaitu mengontrol ventilasi, mempertahankan homeostasis otak dan fungsi tubuh, pemberian sedasi, serta terapi hiperosmolar. Manitol dikenal secara luas sebagai terapi utama pada terapi hipertensi intrakranial, namun larutan salin hipertonik dan natrium laktat hipertonik juga merupakan terapi alternatif yang potensial untuk terapi hipertensi intrakranial. Pemberian obat hiperosmolar pada pasien cedera kepala berat bertujuan untuk menurunkan kadar air dalam daerah interstisial otak akibat efek hiperosmolarnya sehingga terjadi penurunan tekanan intrakranial meskipun terdapat beberapa mekanisme lain yang kemungkinan juga terlibat dalam terjadinya penurunan tekanan intrakranial. Sekarang ini efektivitas cairan hiperosmotik dalam mengurangi edema pada jaringan yang pembuluh darahnya mengalami kerusakan masih dipertanyakan. Bahkan penggunaan obat-obatan tersebut sebagai terapi hiperosmolar diduga malah meningkatkan angka kematian karena dapat memperluas edema sehingga semakin memperburuk peningkatan tekanan intrakranial.Hyperosmolar Therapy in Traumatic Brain InjuryTraumatic brain injury is a common case and related with high morbidity and mortality. Intracranial hypertension and cerebral edema are the main manifestation from severe brain injury and known as main contributor for secondary brain injury, with detrimental neurological outcome. Management of elevated intracranial pressure and cerebral edema are controlling ventilation, maintaining brain homeostasis as well as body function, sedation, and hyperosmolar fluid therapy. Mannitol has been widely known as the main therapy for intracranial hypertension, showever, hypertonic saline and hypertonic sodium lactate are considered as potential alternative therapy for intracranial hypertension. The provision of hyperosmolar theraphy for severe head injury patients aims to reduce water content in the interstitial of the brain for its hyperosmolar effect that would decrease intracranial pressure, even though there probably other mechanism which involve for the decrease of intracranial pressure. In present day, the effectiveness of hyperosmolar fluid in reducing edema in the damaged tissue with impared blood vessel remains questionable. Moreover, the usage of those medication as hyperosmolar therapy allegedly increases mortality because it could adjuct the edema which would exacerbate extension of edema which exacerbate the increase of intracranial pressure.

Target-Controlled Infusion (TCI) Propofol in Ventriculoperitoneal (VP) Shunt Surgery during the First Trimester of Pregnancy Cobis, Albinus Yunus; Bisri, Dewi Yulianti; Rachman, Iwan Abdul
JAI (Jurnal Anestesiologi Indonesia) Publication In-Press
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.73897

Background: The use of target-controlled infusion (TCI) propofol in pregnant patients undergoing ventriculoperitoneal (VP) shunt surgery during the first trimester due to hydrocephalus presents a rare and complex challenge in neuroanesthesia. TCI propofol is favoured for its ability to maintain hemodynamic stability and effectively control intracranial pressure (ICP), both of which are crucial in neuro-obstetric management.Case: A 23-year-old woman, five weeks pregnant, with a history of communicating hydrocephalus and bilateral VP shunts, presented with severe headache. She underwent emergency VP shunt revision under general anesthesia using TCI propofol (Schnider model, target effect-site concentration 2.5–5 mcg/mL), fentanyl (2 mcg/kg), atracurium (0.5 mg/kg), and lidocaine (1.5 mg/kg). Intraoperative hemodynamics remained stable throughout the two-hour procedure. Postoperatively, her neurological status improved significantly, and no complications were observed.Discussion: Compared to inhalational agents such as sevoflurane, TCI propofol demonstrates superior control of ICP, maintains cerebral blood flow stability, and facilitates faster postoperative recovery. Fentanyl, atracurium, and lidocaine were selected due to their favourable safety profiles for short-term use in pregnancy. Postoperatively, progesterone was administered to support pregnancy maintenance by reducing uterine contractility and mitigating the risk of miscarriage associated with surgical and anesthetic stress.Conclusion: TCI propofol is an effective and safe anesthetic strategy for managing VP shunt procedures during the first trimester of pregnancy. A multidisciplinary approach is essential to achieve optimal neurological and obstetric outcomes.

Phenytoin Administration Following Early Postoperative Seizure After Brain Tumor Surgery Nugroho, Andy; Bisri, Dewi Yulianti; Rachman, Iwan Abdul
JAI (Jurnal Anestesiologi Indonesia) Vol 17, No 3 (2025): JAI (Jurnal Anestesiologi Indonesia)
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.73402

Background: Early postoperative seizures (EPS), defined as seizures occurring within seven days following brain surgery, are a common and serious complication, particularly in patients with high-grade gliomas. EPS can prolong hospitalization, impair neurological recovery, and increase the risk of further brain injury. The optimal prophylactic strategy for seizure prevention remains controversial, especially in settings where access to second-generation antiepileptic drugs is limited.Case: A 53-year-old female presented with progressive headaches and was diagnosed with a supratentorial intra-axial tumour consistent with high-grade glioma. She underwent subtotal tumour resection. Four hours postoperatively, the patient developed two episodes of generalized seizures. Immediate management included intravenous administration of midazolam, endotracheal intubation, and phenytoin administration. Diagnostic evaluations excluded metabolic or infectious causes. Near-infrared spectroscopy (NIRS) monitoring indicated stable cerebral oxygenation throughout the postoperative course. The patient experienced no further seizures and demonstrated full neurological recovery. Oral phenytoin was continued for 21 days.Discussion: EPS are associated with multiple risk factors, including tumour location, size, and incomplete resection. In this case, the tumour’s frontal and parietal lobe involvement, large volume, and subtotal excision likely contributed to seizure onset. Phenytoin, despite being a first-generation antiepileptic drug, proved effective in managing EPS and preventing recurrence in the absence of levetiracetam. NIRS served as a useful non-invasive adjunct to monitor cerebral oxygenation after a seizure.Conclusion: Effective early recognition and treatment of EPS are critical in preventing secondary neurological complications. In resource-limited settings, phenytoin remains a viable monotherapy for seizure control post-craniotomy. Individualized, protocol-driven management strategies, supported by neuromonitoring tools such as NIRS, can optimize outcomes in brain tumor surgery.

Co-Authors Abdul Rahman Aisyah Amanda Hanif Aminuyati Andre Aditya Arief Cahyadi Asyer Asyer Bambang J. Oetoro Cobis, Albinus Yunus Dewi Yulianti Bisri Eri Surahman Fitri Sepviyanti Sumardi Fitri Sepviyanti Sumardi Hendro Sudjono Yuwono Iwan Fuadi Jasa, Zafrullah Kany Jasa, Zafrullah Khany Jaya Supriyanto Kulsum Kulsum, Kulsum Longdong, Djefri Frederik Lukman Hidayat Maharani, Nurmala Dewi Mirza Oktavian Nency Martaria Nugroho, Andy Okky Harsono Prihatno, M. Mukhlis Rudi Prihatno, MM. Rudi Putri, Dini Handayani Rose Mafiana Saleh, Siti Chasnak Saleh, Siti Chasnak SATRIYAS ILYAS Sri Rahardjo Sugiarto, Tomi Suwarman Suwarman Syahpikal Sahana Tatang Bisri Tatang Bisri Thomas Thomas Umar, Nazaruddin Widiastuti, Monika

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