Purpose of Review <p>Traumatic injuries are a leading cause of morbidity and mortality in the United States and globally. Many injured patients require surgery and anesthesia, though the ideal choice and dosing of anesthetic induction and maintenance agents to optimize patient outcomes is not widely agreed upon. Sedative agents can lead to or worsen intraoperative hypotension (IOH) in trauma patients who are already prone to hemodynamic instability, potentially exacerbating existing injuries. The goal of this review is to summarize the existing data on commonly used anesthetic agents in trauma patients and identify any gaps in knowledge.</p> Recent Findings <p>It is well-established that IOH worsens patient outcomes in the non-cardiac surgical population, which includes trauma patients. Commonly used induction and maintenance agents can contribute to worsened outcomes by exacerbating hypotension and reducing organ perfusion. Studies are conflicting on whether propofol increases the risk of post-intubation hypotension (PIH), hospital length-of-stay (LOS), and mortality, though some centers advocate for the use of shock-index based reduction in dosing, particularly in neurologically injured patients, to prevent worsening of hypotension. It is generally accepted that etomidate does not increase the risk of post-intubation hypotension compared to other commonly used sedatives including ketamine, but may increase the risk of adrenal suppression with resultant infectious or organ dysfunction complications. Ketamine increases cerebral perfusion pressure (CPP) without appreciable increases in intracranial pressure (ICP) and can be used in neurologically injured patients, assuming the absence of cerebrospinal fluid-obstructing lesions. Regarding volatile anesthetics for maintenance of anesthesia, there has yet to be convincing evidence demonstrating a difference in neurologic outcome, other morbidity, or mortality between sevoflurane, desflurane, and isoflurane. There is no experimental or clinical data that clearly supports the use of one intravenous or volatile agent over any other for maintenance of anesthesia in trauma patients. Injured animal and cellular experiments have shown that dexmedetomidine may have neuroprotective effects as well as anti-inflammatory, lung and gut protective effects when injected intraperitoneally.</p> Summary <p>Propofol, etomidate, and ketamine are all commonly used for induction and intubation of the traumatically injured patient. There is no clear evidence to support the use of one agent over another, as the reduction in blood pressure with propofol can be mitigated with dose reduction or concomitant vasopressor administration. It is important to be aware that selection bias is likely present in existing studies, and the sicker, more hemodynamically unstable patients were probably less likely to receive propofol versus another induction agent such as etomidate or ketamine. Large-scale, multicenter, randomized, controlled, and blinded studies directly comparing all three agents are necessary to determine if anesthesiologists should choose one agent over the others. For maintenance of anesthesia, high-quality human studies evaluating volatile anesthetics agents and total intravenous anesthesia (TIVA) and their effects on morbidity and mortality are lacking and no ideal agent has been identified. Again, multicenter, randomized, controlled, and blinded studies are needed to determine a significant difference in patient outcomes amongst these agents.</p>