Malignant hyperthermia (MH) is one of the most devastating crises encountered in medicine, and it frequently occurs unexpectedly. Since a patient's survival depends on early detection and treatment, a high index of suspicion must be maintained not only by the anesthesiological but also by all surgical personnel in the operating room. Physical stigmata and historical findings can help surgeons to detect those patients who may be at risk for the development of MH. The surgical procedure should be promptly stopped, and medical therapy should be started. Step-by-step treatment of this threatening complication of anesthesia is necessary.