Management of a Malignant Hyperthermia Crisis Without Immediate Access to Dantrolene: A Case Report

Abstract Background Malignant hyperthermia (MH) is an inherited pharmacogenetic disorder characterized by a life-threatening hypermetabolic reaction in skeletal muscle triggered by exposure to volatile anesthetics and succinylcholine in susceptible individuals. Dantrolene is the cornerstone of treatment for MH crisis. Case presentation : Here we present the case of rescuing patients in MH crisis without dantrolene. An 18-year-old man underwent general anesthesia on July 7, 2026, He had no known family history of MH or other neuromuscular disorders. After induction and tracheal intubation, the patient’s end-tidal carbon dioxide increased from 52 to 73 mmHg with severe acidemia(pH 7.077) and arterial carbon dioxide partial pressure of 66.9mmHg.And the patient’s core body temperature raised to 39.7℃ 30 minutes after intubation. The treatment of MH is active cooling, management of hypercapnia with increasing minute ventilation, and correction of severe acidemia. When we got dantrolene ,the patient’s body temperature and end-tide carbon dioxide returned to normality. Conclusion It is possible to rescue patients in MH crisis without dantrolene, with continuous ETCO₂ and core-temperature monitoring, bedside blood gas analysis, active-cooling equipment, and trained personnel. It is important for healthy facilities in regions where dantrolene is unavailable or difficult to obtain.