Propofol anesthesia may induce metabolic disturbances and sevoflurane anesthesia arterial hypotension. This study compares both techniques regarding acid-base and hemodynamic status during intracranial surgery. Sixty-one patients were randomized into 2 groups according to anesthesia maintenance, a propofol group (n=30), and a sevoflurane group (n=31). The anesthesia protocol including rocuronium and remifentanil infusion was otherwise similar in both groups. Arterial blood samples were drawn every 2 hours during the procedure and upon arrival in the intensive care unit to assess acid-base status. The number of hypotensive and hypertensive events served to assess hemodynamic stability. Metabolic acidosis was more frequent during propofol than sevoflurane anesthesia (7 out of 29 and 1 out of 31, P=0.02). Its severity was linearly correlated with lactate concentration (R=0.32), total dose of propofol (R=0.2), and length of procedure (R=0.28). Hyperlactacidemia was also observed during sevoflurane anesthesia, but without acidosis. Hypertension occurred more frequently during propofol than sevoflurane anesthesia (13 out of 30 vs. 1 out of 31, P<0.001), particularly in patients with a past medical history of hypertension. Higher remifentanil infusion rates reduced the risk of hypertension. Conversely, sevoflurane anesthesia favored arterial hypotension (22 out of 31 vs. 12 out of 30, P=0.015). Preoperative morning administration of antihypertensive medications to patients with a history of arterial hypertension was associated with a low probability of hypertensive events, at the cost of more frequent hypotension. In conclusion, propofol anesthesia for intracranial surgery is more frequently associated with lactic acidosis and hypertension; sevoflurane anesthesia may favor arterial hypotension.