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.