What sign of malignant hyperthermia should the nurse assess for during the perioperative period in a child receiving general anesthesia?

• A. Apnea.
• B. Tachypnea.
• C. Bradycardia.
• D. Decreased blood pressure.

Answer: (B)

Malignant hyperthermia is a dangerous, rapidly developing reaction to certain anesthetics that drives a hypermetabolic state in skeletal muscle. As the body starts producing CO2 faster than it can be cleared, ventilation increases to try to blow off the excess CO2, so an early and noticeable change in breathing rate occurs—tachypnea. This is why tachypnea is the best sign to monitor in the perioperative period. Apnea would suggest a failure to ventilate rather than an initial hypermetabolic response, and bradycardia or decreased blood pressure tend to appear later or with more severe progression. Recognizing a fast breathing pattern promptly helps trigger urgent assessment and intervention.