In emergency settings, TIVA should be adjusted in accordance to the pharmacological changes observed in the hypovolemic patient. With the understanding that in those cases there is a decrease in drug requirements, there is a tendency to underdose these patients, increasing the possibility of awareness. Variation in central volume concentration and blood flow redistribution increase plasma drug concentration (Cp). Decreased liver and kidney perfusion, hemodilution and hypothermia, all affect metabolism and clearance of drugs. Changes in drug bioavailability are also observed secondary to changes in plasma protein concentration and acidosis. Changes in pharmacodynamic of target organs are the product of metabolic and temperature disturbances. Due to the nature of hypovolemic shock, most systematic studies have been done in animals. In this condition, the volume of distribution and clearance of fentanyl decreases, increasing decremental times hence requiring bolus and infusion adjustment. Similar changes are observed when using remifentanil, but in this case its contextual half-life is not altered. In the case of etomidate use, most changes are observed on V2 and V3, with a minimal pharmacodynamic variation is observed, thus, requiring no adjustment. When propofol is used, the increase in Cp is proportional to the degree of hypovolemia, adding an increased sensitivity when it reaches over 40%. Data fit to the Eleveld's model (from animal data extrapolation) and simulations in TIVA trainer are shown. Experience shows that these suggestions overestimate the dose, especially within the first 10 minutes. Therefore, it is recommended to reduce the target by 50% in the case of crystalloid-based resuscitation and by 20% when colloids are preferred. Finally, ketamine has been repositioned as an analgesic drug, and is not recommended as a hypnotic, except when used with propofol or benzodiazepines. For propofol, a staggered induction is recommended (together with remifentanil and a neuromuscular blocker), maintaining then the concentration at the site of effect with which the unconsciousness was achieved. The use of EEG monitoring will yield a better titration.