Histopathological results of heparin and heparin-alprostadil administration after intra-arterial sugammadex injection in experimental animal model.

BACKGROUND: Inadvertent intra-arterial injection of sugammadex is rare but may cause serious vascular injury. We investigated vascular damage after intra-arterial sugammadex administration and the effects of heparin alone or combined with alprostadil in a rabbit ear model.

METHODS: Rabbits were randomized into four groups: Group C received no intervention. Groups S, H, and HA received sugammadex; after 5 min, Group H received heparin and Group HA heparin plus alprostadil. Ears were observed for 72 h, amputated, stained with hematoxylin-eosin, and scored (mild, moderate, severe) for inflammation, hemorrhage, necrosis, endothelial loss, and edema. Total and component scores were compared.

RESULTS: Total histopathological scores differed significantly between groups (P = 0.0075) and increased in the order C < HA < H < S (Z = 3.746, P < 0.001). Edema in Groups S and H was similar and greater than that in controls; edema in HA was lower than that in S but higher than that in C. Necrosis and inflammation were comparable in S and H, and both exceeded HA, whose values were close to those of controls. Hemorrhage in HA and S was similar and higher than that in H. Endothelial loss between S, H, and HA did not differ but was greater than that in controls.

CONCLUSIONS: Combined heparin-alprostadil administration after intra-arterial sugammadex injection was associated with reduced necrosis, inflammation, and edema compared with sugammadex alone, whereas heparin did not provide consistent protection. Hemorrhage was not attenuated by either intervention. These hypothesis-generating findings warrant confirmation through larger, mechanistically oriented studies before clinical recommendations can be made.