Anesthetic considerations in a parturient with Freeman–Sheldon syndrome

•We discuss anesthesia for cesarean delivery in a patient with Freeman Sheldon syndrome.•Difficulty with intubation and intravenous access has been reported.•Malignant hyperthermia is a potential complication.•Multidisciplinary cooperation is essential in managing these patients.

Freeman–Sheldon syndrome is a rare genetic disorder characterized by malformations of the face, oral cavity and musculoskeletal system. This case report describes the anesthetic management of a parturient with Freeman–Sheldon syndrome, kyphoscoliosis and a cardiac pacemaker for a cesarean delivery and tubal ligation. With a predicted difficult airway, our team decided to provide a combined spinal–epidural anesthetic. Problems encountered included difficult intravenous access, failure to identify the subarachnoid space and patient discomfort during surgery.