The trauma anesthesiologist has multiple competing concerns when supporting the patient with major trauma, but the priority must be focused on adequate resuscitation to facilitate surgical hemostasis. A broad, evidence-informed knowledge of airway management, resuscitation, physiology, pharmacology, and critical care is required to address the unique pathophysiological processes encountered in trauma. Judicious selection of anesthetic agents is crucial to ensure optimal outcomes. In this review, we describe approaches for the induction and maintenance of general anesthesia for the patient with major trauma. Considerations for ongoing resuscitation and hemodynamic instability will be explored and discussed with respect to the administration of anesthetic induction and maintenance agents. Practices at our institution are reviewed, including the administration of high-dose opioids as an integral part of both resuscitation and anesthesia for the patient with major trauma.