【Abstract】 Objective To investigate the use of vasopressors during surgery and explore the effect of general anesthesia with propofol or sevoflurane on the intraoperative blood pressure of patients with traumatic brain injury (TBI). Methods A total of 214 TBI patients who underwent emergent craniotomy for hematoma evacuation from February 2018 to December 2019 were enrolled and their clinical data were retrospectively analyzed. According to the use of anesthetics, the patients were divided into the two groups: a propofol group (n=120) and a sevoflurane group (n=94). Due to the presence of remarkable baseline differences, they were re‑divided again through propensity score matching. Both groups were compared for the use of vasopressors. The outcome variable was set as the use of vasopressors. The univariate logistic regression analysis was performed to analyze the risk factors of vasopressors use, while the multiple logistic regression analysis was conducted to evaluate the risk of vasopressors use during anesthesia with propofol or sevoflurane. Results The TBI patients were re‑divided by propensity score matching (1∶1), with 84 in each group. According to univariate logistic regression analysis, Glasgow Coma Score (GCS) at admission, diagnosis (subdural hematoma), anesthesia type, anesthesia time, operation (decompressive craniectomy), intraoperative blood loss, intraoperative blood transfusion, and transfusion volume were all related to the use of vasoconstrictor during operation (P<0.05). The multiple regression analysis showed that the rate of vasopressors use in the propofol group was lower than that in the sevoflurane group, with or without adjusting for confounding factors [odds ratio (OR) 0.40 (95%CI 0.16, 0.97), P=0.042]. Conclusions For TBI patients undergoing emergent surgery, the risk of vasopressors use in inhalation anesthesia with sevoflurane is higher, where the circulatory system is more unstable. It is necessary to pay attention to hypotension during operation.