In this episode of the Trauma and Burn Anesthesia Series, we take a deep dive into one of the most critical moments in trauma care: the induction and maintenance of anesthesia in hemodynamically unstable patients. We break down the principles behind choosing the right agents, why dose reductions and careful titration are essential, and how rapid sequence induction sets the standard in trauma. You’ll hear about the role of etomidate and ketamine, why propofol is dangerous in unstable patients, and when vasopressors may actually be appropriate to support induction. We also cover strategies for managing volatile anesthetics, why nitrous oxide should be avoided, and how to prevent intraoperative recall in patients at extremely high risk. From heating strategies to avoid coagulopathy, to lung-protective ventilation in the face of pulmonary injury, and even emergency interventions like thoracotomy and REBOA, this episode takes you through the challenges and nuanced decision-making of trauma anesthesia. If you’ve ever wondered how to balance unconsciousness, perfusion, and safety in critically injured patients, this is the episode for you.

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