A 42-year-old man with neck squamous cell carcinoma underwent awake fiberoptic intubation and tumor resection under general anesthesia. He developed malignant hyperthermia several hours into the surgical procedure. This case highlights malignant hyperthermia’s (MH) variable time course, pathognomonic signs, and the need for rapid diagnosis and treatment. Early recognition and treatment led to rapid resolution of MH. Ongoing discussion of MH is imperative because this disease is often difficult to diagnose early in its time course and may be fatal if not treated expeditiously. Abbreviations: DS - Dantrolene sodium; DSIS - dantrolene sodium injectable suspension; GA - general anesthesia; MH - malignant hyperthermia; EtCO2 - end tidal carbon dioxide; RYR1 - Ryanodine Receptor gene  Key words: Anesthesia, General / methods; Dantrolene / therapeutic use; Diagnosis, Differential; Humans; Malignant Hyperthermia / diagnosis; Malignant Hyperthermia / etiology; Malignant Hyperthermia / physiopathology; Malignant Hyperthermia / therapy Citation: Victor R, Kelly R, Cockrill R, Katrivesis K, Nelson C, Rajan G. A rare case of late onset malignant hyperthermia. Anaesth. pain intensive care. 2022;26(4):546-550; DOI: 10.35975/apic.v26i4.1963 Received: November 19, 2021; Reviewed: April 25, 2022; Accepted: July 12. 2022

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Right Ventricular (RV) dysfunction is a common complication seen in 20-50% of patients after Left-Ventricular Assist Device (LVAD) implantation. Although prediction models exist, it is challenging to prevent RV dysfunction and even more difficult to manage. Early recognition is crucial to determine the appropriate pharmacological therapies and decide if implementation of Mechanical Circulatory Support (MCS) is needed. Here, we present a case of RV dysfunction precipitated unexpectedly by a bradycardic episode. The RV dysfunction was refractory to traditional therapies but was successfully managed with right-sided MCS.