Frontiers in Anesthesiology · Published 2026-07-29 · DOI 10.3389/fanes.2026.1829469
En Chang, Hrach Nalchajyan, Diana A. Fisler, Calvin Lee, Linda L. Cintron, Nadia Nathan
IntroductionMalignant Hyperthermia is a rare, life-threatening pharmacogenetic disorder that can occur after exposure to triggering anesthetic agents, including volatile anesthetics and succinylcholine.Case presentationAn 18-year-old male with multiple traumatic fractures underwent orthopedic surgery under general anesthesia with succinylcholine and sevoflurane. Approximately three hours after induction, he developed acute hyperthermia 39.4 °C (103°F), tachycardia (120–130 beats/min), and hypercarbia with end-tidal CO₂ reaching 58.5 mmHg.InterventionMalignant hyperthermia was suspected intraoperatively. Triggering agents were discontinued, total intravenous anesthesia was initiated, 100% oxygen was administered, active cooling measures were applied, and intravenous dantrolene 260 mg was given, corresponding to approximately 2.5 mg/kg.OutcomesThe patient demonstrated rapid improvement in in temperature and normalization of end-tidal CO₂ after dantrolene administration. He was transferred to the intensive care unit intubated and sedated, received additional dantrolene dosing, was extubated the following day, and ultimately recovered without recurrent malignant hyperthermia symptoms during subsequent surgery after total intravenous and regional anesthesia.ConclusionThis case highlights the importance ofperioperative vigilance, rapid intervention, and careful differentiation from other hypermetabolic crises. Early recognition, discontinuation of triggering agents, and prompt administration of dantrolene are essential to prevent morbidity and mortality in malignant hyperthermia.
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Chang, E., Nalchajyan, H., Fisler, D., et al. (2026). Unmasking malignant hyperthermia: a rapid response to a hypermetabolic crisis: case report. Frontiers in Anesthesiology. https://doi.org/10.3389/fanes.2026.1829469