Ketamine Use in a Laboring Mother With Type 4 Ehlers-Danlos Syndrome, a Family History of Malignant Hyperthermia, and Opioid-Induced Seizures.

Ehlers-Danlos Syndrome (EDS) is a group of inherited, autosomal dominant connective tissue disorders caused by defects in procollagen and collagen production. Vascular EDS, also known as type 4 EDS, involves mutations in the COL3A1 gene, resulting in fragile vascular tissues and compromised organ integrity, which pose significant challenges during both labor and anesthesia. We report the case of a 19-year-old female patient with type 4 EDS, opioid-induced seizures, and a family history of malignant hyperthermia, who presented to the labor ward at 37 weeks of gestation. Due to her complex medical history, traditional methods for labor analgesia, including neuraxial techniques and remifentanil patient-controlled analgesia, were associated with significantly increased risks. A tailored pain management regimen was implemented, consisting of intravenous acetaminophen, cyclobenzaprine, and a ketamine infusion. The patient delivered a healthy neonate without complications. This case highlights the successful use of ketamine for labor analgesia in a high-risk obstetric patient with EDS.