Traumatic spinal cord injury (SCI) occurs with such frequency that clinicians working in acute care, perioperative, and critical care settings will regularly have a direct role in managing these patients. Anesthesia-related concerns begin with the maintenance of spinal motion restriction whenever unstable spine injuries may be present. Airway management may proceed with the use of direct laryngoscopy, video laryngoscopy, or awake fiberoptic intubation. During general anesthesia, avoidance of hypotension is essential for preventing potential spinal cord hypoperfusion and consequent neurological deterioration. When intraoperative neurophysiological monitoring is used, care must be taken not to administer anesthetic agents that may interfere with the accurate detection of the monitored signals. Given the severity of injuries in many of these patients, the frequent need for surgery very soon after injury, and the imperative to maintain adequate blood pressure and oxygenation in the immediate postinjury period, it is clear that the anesthesia team plays a crucial role in helping these patients achieve their best possible outcome.