{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:55:31Z","timestamp":1781744131451,"version":"3.54.5"},"reference-count":44,"publisher":"American Dental Society of Anesthesiology (ADSA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:p>Malignant hyperthermia (MH) is a rare but life-threatening pharmacogenetic disorder triggered by volatile anesthetics and\/or depolarizing muscle relaxants, resulting in a hypermetabolic crisis. We report a case of postoperative fulminant MH in a 26-year-old man who underwent general anesthesia with desflurane and rocuronium for mandibular fracture repair. Despite a history of multiple uneventful anesthetics, the patient developed acute hypercapnia, tachycardia, muscle rigidity, and rapid hyperthermia during emergence, following sugammadex administration. Initial treatment for presumed bronchospasm and postoperative shivering\u2014including sevoflurane sedation, hyperventilation, and inhaled bronchodilators\u2014proved ineffective. A clinical diagnosis of MH was made based on the progression of clinical findings, and treatment with intravenous dantrolene 100 mg, active cooling, and antipyretics was initiated. The patient responded well to intervention and recovered without sequelae. This case highlights the importance of considering MH even in the postoperative phase, particularly with the use of desflurane and potentially contributory agents such as sugammadex and ondansetron. Early clinical suspicion, rapid administration of dantrolene, and supportive measures are critical for favorable outcomes. Anesthesia providers must remain vigilant for MH at all perioperative stages and ensure that emergency protocols, appropriate drug stock, and staff readiness are in place.<\/jats:p>","DOI":"10.2344\/25-0006","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:30:49Z","timestamp":1781742649000},"page":"97-105","source":"Crossref","is-referenced-by-count":0,"title":["Desflurane-Induced Delayed Onset of Malignant Hyperthermia: A Case Report"],"prefix":"10.2344","volume":"73","author":[{"given":"Hideaki","family":"Seki","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Nihon University School of Dentistry, Chiyoda-ku, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niki","family":"Takei","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Nihon University School of Dentistry, Chiyoda-ku, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mie","family":"Kajiwara","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Nihon University School of Dentistry, Chiyoda-ku, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madoka","family":"Tsumura","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Nihon University School of Dentistry, Chiyoda-ku, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nozomi","family":"Naito","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Nihon University School of Dentistry, Chiyoda-ku, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miho","family":"Tsujiuchi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Nihon University School of Dentistry, Chiyoda-ku, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mami","family":"Higa","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Nihon University School of Dentistry, Chiyoda-ku, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuko","family":"Koyanagi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Nihon University School of Dentistry, Chiyoda-ku, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunichi","family":"Oka","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Nihon University School of Dentistry, Chiyoda-ku, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keisuke","family":"Kaneko","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Nihon University School of Dentistry, Chiyoda-ku, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1191","reference":[{"key":"i1878-7177-73-2-97-b01","series-title":"Orphanet J Rare Dis","first-page":"93","article-title":"Malignant hyperthermia: a review","volume":"10","author":"Rosenberg","year":"2015","unstructured":"Rosenberg H,\nPollock N,\nSchiemann A,\nBulger T,\nStowell K. Malignant hyperthermia: a review. Orphanet J Rare Dis. 2015;10:93."},{"issue":"23","key":"i1878-7177-73-2-97-b02","series-title":"JAMA","first-page":"2918","article-title":"Malignant hyperthermia: update on susceptibility testing","volume":"293","author":"Litman","year":"2005","unstructured":"Litman RS,\nRosenberg H. Malignant hyperthermia: update on susceptibility testing. JAMA. 2005;293(23):2918\u20132924."},{"issue":"6","key":"i1878-7177-73-2-97-b03","series-title":"Can J Anaesth","first-page":"709","article-title":"Updated guide for the management of malignant hyperthermia","volume":"65","author":"Riazi","year":"2018","unstructured":"Riazi S,\nKraeva N,\nHopkins PM. Updated guide for the management of malignant hyperthermia. Can J Anaesth. 2018;65(6):709\u2013721."},{"key":"i1878-7177-73-2-97-b04","series-title":"Anesthesiology","first-page":"1138","article-title":"Delayed onset of malignant hyperthermia induced by isoflurane and desflurane compared with halothane in susceptible swine","volume":"78","author":"Wedel","year":"1993","unstructured":"Wedel DJ,\nGemmel SA,\nMilde JH,\nLizzo PA. Delayed onset of malignant hyperthermia induced by isoflurane and desflurane compared with halothane in susceptible swine. Anesthesiology. 1993;78:1138\u20131144."},{"key":"i1878-7177-73-2-97-b05","series-title":"J Anesth","first-page":"307","article-title":"Guidelines for the Management of Malignant Hyperthermia (2016 Edition)","volume":"31","author":"Japanese Society of Anesthesiologists.","year":"2017","unstructured":"Japanese Society of Anesthesiologists. Guidelines for the Management of Malignant Hyperthermia (2016 Edition). 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Suspected recurrence of malignant hyperthermia after post-extubation shivering in the intensive care unit, 18 h after tonsillectomy. Br J Anaesth. 1999;82(6):945\u2013947."},{"issue":"3","key":"i1878-7177-73-2-97-b08","series-title":"Colomb J Anesth","article-title":"Challenges in the management of malignant hyperthermia in Colombia: case report","volume":"53","author":"Lara Rosero","year":"2025","unstructured":"Lara Rosero CA,\nCleves Ruiz W,\nChavarro Aguilar LA. Challenges in the management of malignant hyperthermia in Colombia: case report. Colomb J Anesth. 2025;53(3). Accessed October 25, 2025. https:\/\/www.revcolanest.com.co\/index.php\/rca\/article\/view\/1152"},{"key":"i1878-7177-73-2-97-b09","series-title":"J Pediatr Surg Case Rep","first-page":"2213","article-title":"Malignant hyperthermia without fever in a burned child after bandaging: a case report","volume":"92","author":"Linck J\u00fanior","year":"2023","unstructured":"Linck J\u00fanior A,\nLopes Gabani F,\nMoscardi Gaino M,\nMoscardi Gaino Silva J,\nMattos Urquisa F. Malignant hyperthermia without fever in a burned child after bandaging: a case report. J Pediatr Surg Case Rep. 2023;92:2213\u20135766."},{"issue":"11","key":"i1878-7177-73-2-97-b10","series-title":"N Engl J Med","first-page":"1112","article-title":"The serotonin syndrome","volume":"352","author":"Boyer","year":"2005","unstructured":"Boyer EW,\nShannon M. The serotonin syndrome. N Engl J Med. 2005;352(11):1112\u20131120."},{"issue":"5","key":"i1878-7177-73-2-97-b11","series-title":"Br J Anaesth","first-page":"663","article-title":"Standardized diagnostic criteria for malignant hyperthermia: an update","volume":"122","author":"Larach","year":"2019","unstructured":"Larach MG. Standardized diagnostic criteria for malignant hyperthermia: an update. Br J Anaesth. 2019;122(5):663\u2013669."},{"key":"i1878-7177-73-2-97-b12","series-title":"Int Anesth Res Soc","first-page":"165","article-title":"Delayed onset of malignant hyperthermia in desflurane anesthesia","volume":"96","author":"Hoenemann","year":"2002","unstructured":"Hoenemann CW,\nHalene-Holtgraeve TB,\nBooke M, et al. Delayed onset of malignant hyperthermia in desflurane anesthesia. 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Accessed October 25, 2025. https:\/\/www.mhaus.org\/healthcare-professionals\/be-prepared\/what-should-be-on-an-mh-cart\/"},{"issue":"4","key":"i1878-7177-73-2-97-b15","series-title":"Anaesth Intensive Care","first-page":"453","article-title":"Suspected malignant hyperthermia reactions in New Zealand","volume":"30","author":"Pollock","year":"2002","unstructured":"Pollock AN,\nLangton EE,\nCouchman K,\nStowell KM,\nWaddington M. Suspected malignant hyperthermia reactions in New Zealand. Anaesth Intensive Care. 2002;30(4):453\u2013461."},{"key":"i1878-7177-73-2-97-b16","article-title":"Genetic mystery solved","author":"McCamish","year":"2012","unstructured":"McCamish J. Genetic mystery solved. New Zealand Listener. October 13, 2012. Accessed June 24, 2025. https:\/\/www.noted.co.nz\/archive\/listener-nz-2012\/genetic-mystery-solved"},{"issue":"9","key":"i1878-7177-73-2-97-b17","series-title":"Br J Anaesth","first-page":"1001","article-title":"Atracurium and its antagonism by neostigmine (plus glycopyrrolate) in patients susceptible to malignant hyperthermia","volume":"58","author":"Ording","year":"1986","unstructured":"Ording H,\nNielsen VG. Atracurium and its antagonism by neostigmine (plus glycopyrrolate) in patients susceptible to malignant hyperthermia. Br J Anaesth. 1986;58(9):1001\u20131004."},{"key":"i1878-7177-73-2-97-b18","series-title":"StatPearls","article-title":"Neuromuscular blocking agents","author":"StatPearls","year":"2025","unstructured":"StatPearls. Neuromuscular blocking agents. In: StatPearls. StatPearls Publishing; 2025."},{"key":"i1878-7177-73-2-97-b19","series-title":"Orphanet Journal of Rare Diseases","first-page":"21","article-title":"Malignant hyperthermia","volume":"2","author":"Rosenberg","year":"2007","unstructured":"Rosenberg H,\nDavis M,\nJames D,\nPollock N,\nStowell K. Malignant hyperthermia. Orphanet Journal of Rare Diseases. 2007;2:21. doi:10.1186\/1750-1172-2-21."},{"issue":"1","key":"i1878-7177-73-2-97-b20","series-title":"Clin Anaesth","first-page":"41","article-title":"Dantrolene\u2014a review of its pharmacology, therapeutic use and mode of action","volume":"12","author":"Hopkins","year":"2000","unstructured":"Hopkins PM,\nEllis FR. Dantrolene\u2014a review of its pharmacology, therapeutic use and mode of action. Clin Anaesth. 2000;12(1):41\u201351."},{"issue":"5","key":"i1878-7177-73-2-97-b21","series-title":"Anaesthesia","first-page":"655","article-title":"Malignant hyperthermia 2020: guideline from the Association of Anesthetists","volume":"76","author":"Hopkins","year":"2021","unstructured":"Hopkins PM,\nGirard T,\nDalay S, et al. Malignant hyperthermia 2020: guideline from the Association of Anesthetists. Anaesthesia. 2021;76(5):655\u2013664."},{"key":"i1878-7177-73-2-97-b22","series-title":"ASA Refresh Courses Anesthesiol","first-page":"1","article-title":"Malignant hyperthermia: an update","volume":"42","author":"Wedel","year":"2014","unstructured":"Wedel DJ. Malignant hyperthermia: an update. ASA Refresh Courses Anesthesiol. 2014;42:1\u20138."},{"key":"i1878-7177-73-2-97-b01","series-title":"Orphanet J Rare Dis","first-page":"93","article-title":"Malignant hyperthermia: a review","volume":"10","author":"Rosenberg","year":"2015","unstructured":"Rosenberg H,\nPollock N,\nSchiemann A,\nBulger T,\nStowell K. Malignant hyperthermia: a review. Orphanet J Rare Dis. 2015;10:93."},{"issue":"23","key":"i1878-7177-73-2-97-b02","series-title":"JAMA","first-page":"2918","article-title":"Malignant hyperthermia: update on susceptibility testing","volume":"293","author":"Litman","year":"2005","unstructured":"Litman RS,\nRosenberg H. Malignant hyperthermia: update on susceptibility testing. JAMA. 2005;293(23):2918\u20132924."},{"issue":"6","key":"i1878-7177-73-2-97-b03","series-title":"Can J Anaesth","first-page":"709","article-title":"Updated guide for the management of malignant hyperthermia","volume":"65","author":"Riazi","year":"2018","unstructured":"Riazi S,\nKraeva N,\nHopkins PM. Updated guide for the management of malignant hyperthermia. Can J Anaesth. 2018;65(6):709\u2013721."},{"key":"i1878-7177-73-2-97-b04","series-title":"Anesthesiology","first-page":"1138","article-title":"Delayed onset of malignant hyperthermia induced by isoflurane and desflurane compared with halothane in susceptible swine","volume":"78","author":"Wedel","year":"1993","unstructured":"Wedel DJ,\nGemmel SA,\nMilde JH,\nLizzo PA. Delayed onset of malignant hyperthermia induced by isoflurane and desflurane compared with halothane in susceptible swine. Anesthesiology. 1993;78:1138\u20131144."},{"key":"i1878-7177-73-2-97-b05","series-title":"J Anesth","first-page":"307","article-title":"Guidelines for the Management of Malignant Hyperthermia (2016 Edition)","volume":"31","author":"Japanese Society of Anesthesiologists.","year":"2017","unstructured":"Japanese Society of Anesthesiologists. Guidelines for the Management of Malignant Hyperthermia (2016 Edition). 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Suspected recurrence of malignant hyperthermia after post-extubation shivering in the intensive care unit, 18 h after tonsillectomy. Br J Anaesth. 1999;82(6):945\u2013947."},{"issue":"3","key":"i1878-7177-73-2-97-b08","series-title":"Colomb J Anesth","article-title":"Challenges in the management of malignant hyperthermia in Colombia: case report","volume":"53","author":"Lara Rosero","year":"2025","unstructured":"Lara Rosero CA,\nCleves Ruiz W,\nChavarro Aguilar LA. Challenges in the management of malignant hyperthermia in Colombia: case report. Colomb J Anesth. 2025;53(3). Accessed October 25, 2025. https:\/\/www.revcolanest.com.co\/index.php\/rca\/article\/view\/1152"},{"key":"i1878-7177-73-2-97-b09","series-title":"J Pediatr Surg Case Rep","first-page":"2213","article-title":"Malignant hyperthermia without fever in a burned child after bandaging: a case report","volume":"92","author":"Linck J\u00fanior","year":"2023","unstructured":"Linck J\u00fanior A,\nLopes Gabani F,\nMoscardi Gaino M,\nMoscardi Gaino Silva J,\nMattos Urquisa F. Malignant hyperthermia without fever in a burned child after bandaging: a case report. J Pediatr Surg Case Rep. 2023;92:2213\u20135766."},{"issue":"11","key":"i1878-7177-73-2-97-b10","series-title":"N Engl J Med","first-page":"1112","article-title":"The serotonin syndrome","volume":"352","author":"Boyer","year":"2005","unstructured":"Boyer EW,\nShannon M. The serotonin syndrome. N Engl J Med. 2005;352(11):1112\u20131120."},{"issue":"5","key":"i1878-7177-73-2-97-b11","series-title":"Br J Anaesth","first-page":"663","article-title":"Standardized diagnostic criteria for malignant hyperthermia: an update","volume":"122","author":"Larach","year":"2019","unstructured":"Larach MG. Standardized diagnostic criteria for malignant hyperthermia: an update. Br J Anaesth. 2019;122(5):663\u2013669."},{"key":"i1878-7177-73-2-97-b12","series-title":"Int Anesth Res Soc","first-page":"165","article-title":"Delayed onset of malignant hyperthermia in desflurane anesthesia","volume":"96","author":"Hoenemann","year":"2002","unstructured":"Hoenemann CW,\nHalene-Holtgraeve TB,\nBooke M, et al. Delayed onset of malignant hyperthermia in desflurane anesthesia. Int Anesth Res Soc. 2002;96:165\u2013167."},{"key":"i1878-7177-73-2-97-b13","series-title":"Anesth Analg","first-page":"548","article-title":"A suspected case of delayed onset of malignant hyperthermia with desflurane anesthesia","volume":"98","author":"Papadimos","year":"2004","unstructured":"Papadimos TJ,\nAlmasri M,\nPadgett JC,\nRush JE. A suspected case of delayed onset of malignant hyperthermia with desflurane anesthesia. Anesth Analg. 2004;98:548\u2013549."},{"key":"i1878-7177-73-2-97-b14","article-title":"MH Treatment Protocol","author":"Malignant Hyperthermia Association of the United States.","year":"2023","unstructured":"Malignant Hyperthermia Association of the United States. MH Treatment Protocol. MHAUS; 2023. Accessed October 25, 2025. https:\/\/www.mhaus.org\/healthcare-professionals\/be-prepared\/what-should-be-on-an-mh-cart\/"},{"issue":"4","key":"i1878-7177-73-2-97-b15","series-title":"Anaesth Intensive Care","first-page":"453","article-title":"Suspected malignant hyperthermia reactions in New Zealand","volume":"30","author":"Pollock","year":"2002","unstructured":"Pollock AN,\nLangton EE,\nCouchman K,\nStowell KM,\nWaddington M. Suspected malignant hyperthermia reactions in New Zealand. Anaesth Intensive Care. 2002;30(4):453\u2013461."},{"key":"i1878-7177-73-2-97-b16","article-title":"Genetic mystery solved","author":"McCamish","year":"2012","unstructured":"McCamish J. Genetic mystery solved. New Zealand Listener. October 13, 2012. Accessed June 24, 2025. https:\/\/www.noted.co.nz\/archive\/listener-nz-2012\/genetic-mystery-solved"},{"issue":"9","key":"i1878-7177-73-2-97-b17","series-title":"Br J Anaesth","first-page":"1001","article-title":"Atracurium and its antagonism by neostigmine (plus glycopyrrolate) in patients susceptible to malignant hyperthermia","volume":"58","author":"Ording","year":"1986","unstructured":"Ording H,\nNielsen VG. Atracurium and its antagonism by neostigmine (plus glycopyrrolate) in patients susceptible to malignant hyperthermia. Br J Anaesth. 1986;58(9):1001\u20131004."},{"key":"i1878-7177-73-2-97-b18","series-title":"StatPearls","article-title":"Neuromuscular blocking agents","author":"StatPearls","year":"2025","unstructured":"StatPearls. Neuromuscular blocking agents. In: StatPearls. StatPearls Publishing; 2025."},{"key":"i1878-7177-73-2-97-b19","series-title":"Orphanet Journal of Rare Diseases","first-page":"21","article-title":"Malignant hyperthermia","volume":"2","author":"Rosenberg","year":"2007","unstructured":"Rosenberg H,\nDavis M,\nJames D,\nPollock N,\nStowell K. Malignant hyperthermia. Orphanet Journal of Rare Diseases. 2007;2:21. doi:10.1186\/1750-1172-2-21."},{"issue":"1","key":"i1878-7177-73-2-97-b20","series-title":"Clin Anaesth","first-page":"41","article-title":"Dantrolene\u2014a review of its pharmacology, therapeutic use and mode of action","volume":"12","author":"Hopkins","year":"2000","unstructured":"Hopkins PM,\nEllis FR. Dantrolene\u2014a review of its pharmacology, therapeutic use and mode of action. Clin Anaesth. 2000;12(1):41\u201351."},{"issue":"5","key":"i1878-7177-73-2-97-b21","series-title":"Anaesthesia","first-page":"655","article-title":"Malignant hyperthermia 2020: guideline from the Association of Anesthetists","volume":"76","author":"Hopkins","year":"2021","unstructured":"Hopkins PM,\nGirard T,\nDalay S, et al. Malignant hyperthermia 2020: guideline from the Association of Anesthetists. Anaesthesia. 2021;76(5):655\u2013664."},{"key":"i1878-7177-73-2-97-b22","series-title":"ASA Refresh Courses Anesthesiol","first-page":"1","article-title":"Malignant hyperthermia: an update","volume":"42","author":"Wedel","year":"2014","unstructured":"Wedel DJ. Malignant hyperthermia: an update. ASA Refresh Courses Anesthesiol. 2014;42:1\u20138."}],"container-title":["Anesthesia Progress"],"original-title":[],"link":[{"URL":"https:\/\/anesthesiaprogress.kglmeridian.com\/view\/journals\/anpr\/73\/2\/article-p97.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/anesthesiaprogress.kglmeridian.com\/downloadpdf\/journals\/anpr\/73\/2\/article-p97.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/anesthesiaprogress.kglmeridian.com\/downloadpdf\/journals\/anpr\/73\/2\/article-p97.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:30:51Z","timestamp":1781742651000},"score":1,"resource":{"primary":{"URL":"https:\/\/anesthesiaprogress.kglmeridian.com\/view\/journals\/anpr\/73\/2\/article-p97.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":44,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.2344\/25-0006","relation":{},"ISSN":["1878-7177","0003-3006"],"issn-type":[{"value":"1878-7177","type":"electronic"},{"value":"0003-3006","type":"print"}],"subject":[],"published":{"date-parts":[[2026,6]]}}}