An anesthesiological complication related to bone cement use during reconstructive osteoplasty using the Masquelet...

A 16-year-old male (ASA II, BMI 31) underwent reconstructive osteoplasty with insertion of a polymethylmethacrylate (PMMA) spacer. Shortly after cement application, he developed sudden hypotension, tachycardia, and decreased end-tidal CO₂, consistent with Grade II BCIS. Supportive management with fluids, ketamine, and norepinephrine stabilized the patient. Postoperatively, he experienced recurrent hypotension, acute kidney injury, and elevated liver enzymes and creatine kinase. Intensive care treatment resulted in recovery, and he was discharged from the ICU on day five. Bone cement implantation syndrome, though exceptionally uncommon in pediatric patients, may develop during orthopedic procedures involving polymethylmethacrylate. Early recognition, continuous anesthetic vigilance, and timely multidisciplinary intervention are crucial to reduce morbidity and improve perioperative outcomes.