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All Journal BALI MEDICAL JOURNAL (BMJ) Medicina E-Jurnal Medika Udayana Jurnal Anestesiologi Indonesia Bali Journal of Anesthesiology Syntax Literate: Jurnal Ilmiah Indonesia ISM (Intisari Sains Medis) : Jurnal Kedokteran Bioscientia Medicina : Journal of Biomedicine and Translational Research PREPOTIF : Jurnal Kesehatan Masyarakat Neurologico Spinale Medico Chirurgico JOURNAL LA MEDIHEALTICO Archives of The Medicine and Case Reports Bioscientia Medicina : Journal of Biomedicine and Translational Research Journal of Anesthesiology and Clinical Research Jurnal Neuroanestesi Indonesia Majalah Anestesia & Critical Care (MACC) Journal of Global Pharma Technology Eduvest - Journal of Universal Studies Jurnal Komplikasi Anestesi Journal of Medicine and Health Jurnal Anestesi dan Terapi Intensif Udayana Jurnal Anestesiologi dan Terapi Intensif
Tjokorda Gde Agung Senapathi
Departemen Anestesiologi Dan Terapi Intensif Fakultas Kedokteran Universitas Udayana – RSUP Sanglah Denpasar, Indonesia
Aerospace Engineering Humanities Biochemistry, Genetics & Molecular Biology Computer Science & IT Education Environmental Science Health Professions Immunology & microbiology Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Neuroscience Nursing Physics Public Health Social Sciences Veterinary Other

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Scalp Nerve Block in Combination to General Anesthesia Lower the Increase of Inflammatory Markers Compared to General Anesthesia alone in Craniotomy Surgeries Tjokorda Gde Agung Senapathi
Journal of Global Pharma Technology Volume 12 Issue 02 (2020) Feb. 2020
Publisher : Journal of Global Pharma Technology

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Abstract

Background: Regional anesthesia reduces the inflammatory response and surgery-related immunosuppressive response. The scalp nerve block technique is a relatively simple and safe technique. The goal of this study was to compare the inflammatory response between a combination of general anesthesia and scalp nerve block compared with general anesthesia in craniotomy surgery. Methods: This was a double-blind, randomized controlled trial with pre and post-test study in 50 subjects carried out at Sanglah General Hospital (Bali, Indonesia). Group A treated with scalp nerve block using 0.25% levobupivacaine solution, and group B treated with scalp nerve block using 0.9% NaCl solution. Blood tests were carried out before and after the surgery to measure platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP) as inflammatory markers. Results: The mean difference of PLR, NLR, and CRP between the two groups were significantly different (p <0.001) at 72 hours after the surgery. The tests found no significant difference at before and right after the surgery (p >0.05). Conclusion: The application of scalp nerve block in combination to general anesthesia lower the increase of PLR, NLR, and CRP compared to general anesthesia alone in craniotomy surgeries.Keywords: PLR, NLR, CRP, Inflammation, Regional anesthesia.
The Effectivity of Clonidine Addition to Levobupivacaine 0.25% for Scalp Block in Patients Underwent Craniotomy Surgery Tjokorda Gde Agung Senapathi
Journal of Global Pharma Technology Volume 11 Issue 08 (2019) Aug. 2019
Publisher : Journal of Global Pharma Technology

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Background: The scalp nerve block technique is a relatively simple and safe technique. Clonidine is well-known as an agent that extends the analgesia effect of local anesthetic drugs. The goal of this study was to evaluate the effectiveness of clonidine addition as adjuvants in levobupivacaine 0.25% in scalp nerve block in craniotomy procedures. Patients and Methods: This was a clinical trial with a double-blind, randomized study using consecutive sampling technique. Inclusion criteria include patients underwent craniotomy surgery due to brain tumor using general anesthesia with endotracheal tube in 18-60 years of age. As an addition to general anesthesia, group a received levobupivacaine 0.25% and clonidine 2 µg/kg as a regiment for scalp block. Group B received levobupivacaine only for the same purpose. All other treatments were similar for both groups. Results: The intraoperative fentanyl requirement (100 (50-150) vs. 150 (75-200) mcg, p <0.001), the period to the postoperative first PCA dose (822.5±129.7 vs. 387.8±69.6 minutes, p <0.001), and the total need of postoperative morphine by PCA (2.0 (1.0-3.0) vs. 3.0 (2.0-7.0) mg, p <0.001) were lower in the clonidine-added levobupivacaine groups compared to levobupivacaine alone. 3 Conclusions: The addition of clonidine to levobupivacaine 0.25% on scalp block is effective in reducing the need for intraoperative and postoperative opioids, reducing postoperative pain, extending the duration of scalp nerve block, and delaying the first PCA dose.Keywords: Clonidine, Levobupivacaine, Fentanyl, Morphine, Pain, Requirements.
Effectiveness of Intravenous Subanesthetic Dose of Ketamine on the Subarachnoid Block to Attenuate Inflammation Response in Transurethral Resection of the Prostate Surgeries Tjokorda Gde Agung Senapathi
Journal of Global Pharma Technology Volume 11 Issue 08 (2019) Aug. 2019
Publisher : Journal of Global Pharma Technology

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Background: Perioperative anesthesia and surgery can induce a stress response in the body. Regional anesthesia with local anesthetic drugs in the transurethral Resection of the Prostate (TUR-P), has been proven to minimize inflammation. Patients and Methods: Forty-eight patients of ASA I-II, scheduled for TUR-P with spinal subarachnoid anesthesia were randomly divided into two groups, group A with ketamine and group B without ketamine. The blood level of interleukin (IL)-10, IL-8, C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and IL-10/IL-8 ratio were measured in both groups at 1 hour before operation, also at 1 and 24 hours after operation. Results: Blood level of IL-10 (p<0.001) and IL-10/IL-8 Ratio (p<0.05) were significantly different with higher values on group A. Other parameters were not found to be different. Conclusion: Subanesthetic dose of ketamine on spinal subarachnoid anesthesia technique done for TUR-P operation was found able to control inflammation and prevent the deterioration of immune system perioperatively.Keywords: IL-10, IL-8, CRP, NLR, Benign prostatic hyperplasia.
Patients’ Characteristics and Initial Therapy at Diabetic Center of Sanglah General Hospital in 2018 Tjokorda Gde Agung Senapathi
Journal of Global Pharma Technology Volume 12 Issue 01
Publisher : Journal of Global Pharma Technology

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Background: Diabetes mellitus (DM) is a chronic disease that requires medical treatment and education to prevent acute or chronic complications. Until today, there have been no published records in the incidence of DM in Bali. The goal of this study was to observe the characteristics of patients who visited Diabetic Center of Sanglah General Hospital in 2018. Methods: This was a cross-sectional, retrospective study. The subjects of this study were all patients newly-diagnosed with DM, aged 18 or older, who came to the Diabetic Center of Sanglah General Hospital. The sampling method was all-inclusive sampling. We recorded the age, sex, body height, body weight, body mass index (IMT), baseline fasting blood sugar, and baseline HbA1C. The data were analyzed descriptively.  Results: In 2018, 1,145 patients visited the Diabetic Center of Sanglah General Hospital. The majority of the subjects were men (66.11%), with the most frequent age-group was the 50-69 years age group (69.08%). As many as 117 patients received OADs as initial therapy, while 840 received insulin, and the remaining 665 received a combination of both OAD and insulin.  Conclusions: There were 1,145 patients visited the Diabetic Center of Sanglah Hospital in 2018, with the highest age-group was the 50-69 years age group. Only a small number of them received OADs as initial therapy, and most of received the combination of insulin and OADs.Keywords: Diabetes mellitus, Age, Sex, Bali, Indonesia.
Prothrombin Complex Concentrate as a Key Adjunct in Massive Hemorrhage Management in Placenta Accreta Spectrum Disorder: A Case Report Pramana, Putu Bagus Gin Gin; Tjokorda Gde Agung Senapathi; Pontisomaya Parami; Tjahya Aryasa
Archives of The Medicine and Case Reports Vol. 5 No. 3 (2024): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v5i3.599

Abstract

Placenta accreta spectrum disorder (PASD) is a severe obstetric complication associated with significant hemorrhage risk. This report highlights the successful use of prothrombin complex concentrate (PCC) as part of a multidisciplinary approach to managing a case of massive hemorrhage in PASD. A 36-year-old woman, G3P2002, at 33 weeks gestation, diagnosed with placenta previa totalis and suspected PASD, underwent a planned cesarean hysterectomy. The surgery was complicated by 5200 mL hemorrhage due to placental invasion and bladder injury. Hemodynamic instability was managed with massive transfusion protocol activation, including PCC, tranexamic acid, and packed red blood cells. Intra-abdominal packing was performed for hemostasis, and the bladder injury was repaired. Continued PCC administration in the ICU, along with other supportive measures, resulted in hemorrhage control and stabilization. The patient was successfully extubated and discharged after a second surgery to remove packing. This case emphasizes the vital role of PCC in the multidisciplinary management of massive hemorrhage in PASD. Early recognition of PASD risk factors and prompt intervention, including PCC administration, are crucial for optimal maternal outcomes.
THE CORRELATION BETWEEN TYPE 2 DIABETES MELLITUS WITH BACTERIAL INFECTION IN COVID-19 PATIENTS ADMITTED TO INTENSIVE CARE UNIT AT CENTRAL GENERAL HOSPITAL PROF. DR. I.G.N.G. NGOERAH DENPASAR IN 2021-2022 Bayu Saputra, Ida Bagus Prema Satia; Suranadi, I Wayan; Senapathi, Tjokorda Gde Agung
E-Jurnal Medika Udayana Vol 13 No 2 (2024): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2024.V13.i02.P10

Abstract

Type 2 Diabetes Mellitus (T2DM) has a detrimental impact on the immune system, resulting in a decrease in the body's immune response, making patients highly susceptible to bacterial infections. Patients with T2DM, especially those treated in the Intensive Care Unit (ICU) of a hospital, face an increased risk of infection. The emergence of COVID-19, which also infects T2DM patients, further diminishes the immune system's function in these patients. Consequently, individuals with both T2DM and COVID-19 are at a heightened risk of developing secondary infections, commonly referred to as Hospital-Acquired Infections.This research aims to explore the relationship between T2DM, assessed through blood sugar levels, and the occurrence of bacterial infections in COVID-19 patients treated in the ICU of Prof. Dr. I.G.N.G. Ngoerah Central Hospital from 2021 to 2022. The research design employed is quantitative analytical correlational study using a cross-sectional approach, with a sample size of 98 patients collected from the Medical Records and Hospital Management System of Prof. Dr. I.G.N.G. Ngoerah Central Hospital in Denpasar. This study found that there is a significant correlation between patient’s infection profile with random blood glucose levels with an Odds Ratio (OR) of 1.15 (95% CI: 1.04 – 1.27; p = 0.013). Additionally, a significant relationship was observed between the severity of COVID-19 and bacterial infections in patients, with an Odds Ratio of 1.12 (95% CI: 1.01 – 1.26; p = 0.04). Keywords : T2DM, ICU, Hospital-Acquired Infection
Perbandingan Efektivitas Campuran Propofol dengan Ketamin, Fentanil dan Lidokain dalam Mengurangi Nyeri dari Injeksi Propofol: Telaah Sistematis Christopher, Michael; Senapathi, Tjokorda Gde Agung; Suarjaya, I Putu Pramana; Dewi, Dewa Ayu Mas Shintya
E-Jurnal Medika Udayana Vol 11 No 8 (2022): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2022.V11.i8.P02

Abstract

Propofol merupakan obat sedasi yang sering digunakan di prosedur di rumah sakit. Propofol memiliki efektivitas yang baik dalam menginduksi efek sedasi dan memiliki efek samping yang sangat minimal. Kekurangan dari penggunaan propofol ini adalah nyeri, dan nyeri ini memiliki insiden yang tinggi. Nyeri ini dapat dikurangi dengan berbagai faktor, salah satunya adalah menggunakan obat analgesia lokal lainnya seperti lidokain, fentanil dan ketamin. Telaah sistematis ini bertujuan merekam dari berbagai uji klinis acak yang terdapat di berbagai sumber literatur. Tahun penelitian dibatasi dari tahun 2016 hingga 2020. Penulis menggunakan kriteria kelayakan PICOS. Obat yang akan digunakan adalah lidokain, fentanil dan ketamin. Penulis juga menggunakan Jadad Scale untuk mengetahui risiko bias dari masing-masing penelitian yang sudah masuk kriteria inklusi. Penulis menggunakan Funnel Plot untuk mengetahui publikasi bias dari masing-masing studi. Telaah sistematis ini telah meneliti sebanyak 2130 sampel manusia yang didapat dari 25 penelitian. Penelitian-penelitian ini memiliki kelompok penelitian lagi untuk membandingkan hasil percobaan klinis oleh peneliti terkait. Hasilnya adalah induksi sedasi dengan kejadian nyeri paling rendah adalah penggunaan propofol 0,33% 6 ml dengan dosis 2,5 mg/kgBB dengan skor rata-rata nyeri 0,08. (p>0,05) Kata kunci : propofol, nyeri, skala nyeri
Angka kejadian nyeri kepala pasca anestesia spinal pada pasien paskaoperasi seksio sesarea Parami, Pontisomaya; Wiryana, Made; Senapathi, Tjokorda Gde Agung; Ryalino, Christopher; Pradhana, Adinda Putra; Narakusuma, I Putu Fajar
E-Jurnal Medika Udayana Vol 11 No 12 (2022): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2022.V11.i12.P02

Abstract

Nyeri kepala pasca anestesia spinal merupakan salah satu resiko dari anestesi neuraksial yang terjadi setelah prosedur anestesi spinal akibat tusukan dural atau robekan selama dilakukannya anestesi yang dapat disertai dengan gejala mual, muntah, serta gangguan pendengaran dan penglihatan. Tujuan penelitian ini adalah untuk melihat angka kejadian nyeri kepala pasca spinal anestesia pada pasien pasca operasi seksio sesarea di RSUP Sanglah Denpasar. Penelitian ini merupakan penelitian deskriptif potong lintang yang dilakukan terhadap semua pasien yang menjalani operasi dengan teknik anestesia spinal di RSUP Sanglah Denpasar selama periode tiga bulan di tahun 2021. Sebanyak tiga sampel dieksklusi karena sebelumnya telah memiliki riwayat nyeri kepala, sehingga diperoleh total 109 sampel. Kuisioner diisi sesuai jawaban responden pada hari ke-2 dan ke-5 paskaoperasi. Hasil penelitian menunjukkan angka kejadian nyeri kepala pasca anestesia spinal pada hari kedua dan hari kelima paskaoperasi adalah sama yaitu sebesar 2%, seluruhnya merupakan nyeri kepala dengan derajat ringan.
INCIDENCE OF HYPOTENSION AND NAUSEA VOMITING IN SUBARACHNOID BLOCK ANESTHESIA TECHNIQUE IN CESAREAN SURGERY Nandaswari, Ni Made Nilam; Parami, Pontisomaya; Suranadi, I Wayan; Senapathi, Tjokorda Gde Agung
E-Jurnal Medika Udayana Vol 13 No 3 (2024): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2024.V13.i03.P03

Abstract

Hypotension and nausea vomiting are common side effects in patients undergoing cesarean surgery with subarachnoid block anesthesia techniques. Cases of hypotension and nausea vomiting in this case are often found but research data in Indonesia, especially in Bali, is still very limited. Therefore, this research is important to do with the aim of knowing the incidence of hypotension and nausea vomiting in cesarean surgery with the subarachnoid block anesthesia technique at Prof. Dr. I.G.N.G Ngoerah General Hospital Denpasar. This study used a prospective cross-sectional observational descriptive method. The study data were taken from the presence or absence of hypotension and nausea vomiting during and after cesarean surgery from April 2022 – June 2022. The data were analyzed using Microsoft Excel 2013 software to obtain characteristics of patient demographic data in the form of maternal age and gestational age, patient distribution based on height of sensory blockade, type and dose of antiemetics, type and dose of opioids, bleeding, incidence of hypotension, and incidence of nausea vomiting. The results showed that the number of patients who experienced hypotension was 13 people (28.3%), and those who did not experience hypotension were 33 people (71.7%). A total of 30 people (65.2%) patients did not experience nausea vomiting, 8 people (17.4%) experienced nausea and 8 people (17.4%) experienced vomiting. By taking good precautions, it can reduce the side effects of hypotension and nausea vomiting.
KARAKTERISTIK NYERI PASCA-OPERASI ORTOPEDI DI RSUP SANGLAH PERIODE OKTOBER-DESEMBER 2020 Eugenia, Michelle; Dewi, Dewa Ayu Mas Shintya; Senapathi, Tjokorda Gde Agung; Wiryana, I Made
E-Jurnal Medika Udayana Vol 11 No 10 (2022): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2022.V11.i10.P07

Abstract

Nyeri merupakan salah satu aspek penting dalam menentukan kualitas hidup seseorang. Salah satu nyeri yang sering terjadi adalah nyeri akibat tindakan intervensi bedah atau operasi yang biasa sering disebut nyeri pasca-operasi. Apabila nyeri ini tidak ditangani dengan baik maka akan memengaruhi kualitas hidup pasien dan sangat berhubungan dengan penatalaksanaan nyeri tersebut. Penelitian ini bertujuan untuk mengetahui karakteristik nyeri pasien pasca-operasi ortopedi melalui pendataan Acute Pain Service (APS) di Rumah Sakit Umum Pusat Sanglah pada periode Oktober-Desember 2020. Penelitian ini menggunakan metode descriptive cross-sectional. Data yang digunakan diambil dari rekapan data sekunder Acute Pain Service (APS) di RSUP Sanglah. Total sampel yang digunakan dalam penelitian ini adalah 195 pasien pasca-operasi ortopedi. Berdasarkan penelitian, diperoleh bahwa yang paling banyak menjalani operasi ortopedi adalah pasien laki-laki usia dewasa pada daerah ekstremitas inferior. Tatalaksana nyeri yang paling banyak digunakan adalah kombinasi obat intravena opioid dan oral parasetamol. Dari keseluruhan sampel, diperoleh paling banyak pasien mengalami intensitas nyeri ringan, yaitu 176 pasien (90,3%). Berdasarkan pembagian kelompok jenis kelamin, umur, jenis operasi, dan tatalaksana juga diperoleh bahwa sebagian besar pasien mengalami nyeri ringan. Kata kunci : Nyeri pasca-operasi, Operasi ortopedi, RSUP Sanglah
Co-Authors A A Gde Putra Semara Jaya Adinda Putra Pradhana Albert Albert Anak Agung Gde Agung Adistaya Andi Irawan Andi Kusuma Wijaya, Andi Anggreni, Anak Agung Ayu Aprilnita, Aida Aryasa EM, Tjahya Astawa N. M., Astawa N. Astawa P., Astawa Astuti, Mira Kusuma Astuti, Mira Kusuma Bayu Saputra, Ida Bagus Prema Satia Brillyan Jehosua Toar Budiadnyana, I Made Pasek Budiarta, Gede Cahyono, Ardy Wibowo Christopher Ryalino Christopher, Michael Cindryani Ra Ratumasa, Marilaeta Cung Flavyanto, Eugenius Silvester Cynthia Dewi Sinardja D.H., Asterina David Rendra Mahardika Dewa Ayu Mas Shintya Dewi Dewi, Dewa Ayu Mas Shintya Dewi, I Dewa Ayu Mas Shintya Doddy Setiawan Ekaputra Ekaputra, Ekaputra Elisma Nainggolan, Elisma EM, Tjahya Aryasa Emkel Perangin Angin, Emkel Eric Makmur, Eric Ery Oktadiputra Estrada, Ronald Eugenia, Michelle Ferry, Ferdinand Gede Semarawima, Gede Gede Wirya Kusuma Duarsa Giovanni, Malvin Hadiwijono, Vanessa Juventia Hartanto, Wijaya Hartawan , I.G.A.G. Utara Hartawan, IGAG Utara Hengky Hengky, Hengky Humianto, Michael I Dewa Made Sukrama I Gede Budiarta I Gede Prima Julianto I Gusti Agung Gede Utara Hartawan I Gusti Ayu Putri Purwanthi I Gusti Ngurah Mahaalit Aribawa I Ketut Sinardja I Ketut Wibawa Nada I Made Agus Kresna Sucandra I Made Bakta I Made Darma Junaedi, I Made I Made Gede Widnyana I Made Prema Putra I Made Subagiartha I Made Wiryana, I Made I Putu Agus Surya Panji I Putu Fajar Narakusuma I Wayan Aryabiantara, I Wayan I Wayan Suranadi Ida Bagus Krisna Jaya Sutawan IGNA Putra Arimbawa, IGNA Putra Jayantha Ananda, I Gusti Ngurah Bagus Jeanne, Bianca Jhoni Pardomuan Pasaribu Jimmy Wongkar Johanes, Kevin Paul Junaedi, I Made Darma Kadek Agus Heryana Putra Kadek Agus Heryana Putra, Kadek Agus Kamaswari, Ida Ayu Dwi Kenzi, Ignatio Armando Ketut Semara Jaya, Ketut Semara Ketut Wibawa Nada Ketut Yudi Arparitna, Ketut Yudi Komang Ady Widayana Komang Alit Artha Wiguna Komang Alit Artha Wiguna Kurnia, Prajnaariayi Prawira Kurniyanta, I P Kurniyanta, I Putu Kusuma, Oscar Indra Labobar, Otniel Adrians Leo, Joseph Nelson Lesmana, Pita Mora Leton, Yohanes PT Made Agus Kresna Sucandra Made Agus Kresna Sucandra, Made Agus Kresna Made Bagus Cahya Maha Putra Made Widnyana Made Wiryana Marilaeta Cindryani Marilaeta Cindryani Lolobali, Marilaeta Cindryani Marilaeta Cindryani, Marilaeta Marting, Millenia Mauritius Septa Murti, Dede Taruna Kreisnna Nada, I Ketut Wibawa Nandaswari, Ni Made Nilam Narakusuma, I Putu Fajar Ni Nyoman Sri Budayanti Ni Putu Novita Pradnyani, Ni Putu Novandi Kurniawan Pande Nyoman Kurniasari, Pande Panji, I PAS Patricia, Yoshie Pontisomaya Parami Pramana, Putu Bagus Gin Gin Pranoto, Theodorus Pascalis Yullie Pratana, Yolanda Jenny Putu Agus Surya Panji Putu Herdita Sudiantara, Putu Herdita Putu Kurniyanta Putu Pramana Suarjaya Ra Ratumasa, Marilaeta Cindryani Raka-Sudewi A. A. Ratumasa, Marilaeta Cindryani Ra Reynaldi Reiky Hadiwijaya Riko Riko Santo, Budi Saputra, Darmawan Jaya Satoto D., Satoto Satria Pinanditas S Sidabutar, Beny Pratama Sidemen, I Gusti Ayu Eka Para Santi Sidemen, I.G.P.Sukrana Sidemen, IGP Sukrana Sonni Soetjipto, Sonni Sri Maliawan Stefanus Taofik stefanus taofik, stefanus Suarjaya, I PP Suastika, I Gede Juli Sucandra, I Made Agus Kresna Sucandra, I MK Sumanti, Alan F. A. Sunanda Naibaho Suranadi , I Wayan Suryadi N. T., Suryadi N. Suryana, I Ketut Syamsuddin, Johanis Bosco Troy Tanuwijaya, Tommy M Tirta, Ian Tjahya Aryasa Tjahya Aryasa Tjahya Aryasa E M Tjokorda Gde Bagus Mahadewa Togi Stanislaus Patrick Virayanti, Luh Putu Diah W. A., W. Wardani, Dinar Kusuma Welly, Julian Widnyana, I MG Widyana, I Made Gede Wiryana M., Wiryana Yadikusumo, Andrian Yustisia, Putu Ngurah Krisna Denta