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Background: Tramadol hydrochloride (HCl) and ketorolac tromethamine are analgesic drugs, which are commonly used in combination in postoperative pain management. According to some studies, metoclopramide and magnesium sulfate (MgSO4 ) as adjuvant agents can improve analgesia and decrease the need for other pain drugs. Materials and Methods: The chemical stability of tramadol HCl combined with ketorolac tromethamine and metoclopramide HCl has been studied using a stability-indicating high-performance liquid chromatographic assay method. Calibration curves were produced using linear regression of the peak area against concentration of each drug, with an r 2 value ≥ 0.96. Our aim was to investigate the stability of admixture solution of tramadol HCl combined with ketorolac tromethamine and metoclopramide HCl for 48 h (25°C) and 5 days (5°C), with MgSO4 , which has never been assessed. Results: Data obtained for admixtures prepared and stored at temperatures of 25°C and 5°C, show that all drugs have reached at least 98% of the initial concentration. Conclusions: For the purpose of pre-preparing drug admixtures to use with confidence, tramadol HCl infusions may be prepared in advance and then thawed before use in clinical units. On the basis of our results, the intravenous mixture of tramadol (7.69 mg/mL), metoclopramide (0.19 mg/mL), ketorolac (1.15 mg/mL), and magnesium sulfate (77 mg/mL) may be considered for a possible commercial formulation.

Rationale: Malnutrition (M) is a multifactorial process in children with chronic liver disease and carries an increased risk of morbidity and mortality. Maintaining optimal NS can prevent further derangement of liver function: increasing metabolic energy and improving the immunology status. In fact, M adversely affects on the outcome of surgical patients (pts). In this study we intend to demonstrate how the NS can influence the outcome of liver transplant (LTx) in the paediatric population. Methods: We evaluated 74 paediatric pts over 24 months from 2006 to 2007 who underwent LTx at ISMETT. The age of the pts ranged between 18 months and 12 years. The causes of the LTX were: 43%biliary atresia, 10%hepatoblastoma, 10%acute fulminant hepatitis, 7%graft non function, 5%autoimmune hepatitis and 25%other. Upon admission, the pts undergo a nutritional screening by a multidisciplinary team (physicians, clinical pharmacists, dietitians) who assess the NS and establish a customized nutritional plan based on the clinical needs. The nutritional assessment includes: clinical history, a retrospective analysis of the NS, anthropometrical (National Center of Health Statistics Tables) and biochemistry data. Results: Of the 74 pts assessed immediately before the LTx, 14 were between 3o-5opercentile weight/height (wt/ht): severe M, 20 were between 10o-25o: moderate M, 30 between 25o-50o: normal NS and only 5 pts were above 50o: good NS. Of the 14 pts between 3o-5opercentile wt/ht, there were 2 deaths and 7 pts underwent redo-LTx and the average length of stay (LOS) was 50 days. Of the 20 pts between 10o-25opercentile wt/ht only 2 underwent redo-LTx and 12 had post-surgery complications, the average LOS was 30 days. Of the 35 pts between 25o50opercentile wt/ht there was 1 death and 7 pts had complications post-surgery while the average LOS was around 30 days. Conclusion: As the results show, the NS can effectively be a prognostic indicator in the LTx, as optimal nutrition may prevent further derangement of liver function.