Propofol is a global central nervous system depressant. Propofol general anesthesia decreases cerebral metabolic rate for oxygen (CMRO2), cerebral blood flow (CBF), and intracranial pressure (ICP). Decrease in CBF is more than sevoflurane. Propofol is a cerebral vasoconstrictor and thus lowers ICP.
Propofol decreases ICP greater than isoflurane and sevoflurane while cerebral perfusion pressure is more in propofol. Large doses of propofol general anesthesia may decrease systemic blood pressure sufficiently to also decrease cerebral perfusion pressure.
Cerebral carbon dioxide reactivity and cerebral pressure auto regulation remain intact with propofol. However, large propofol general anesthesia doses or fast propofol infusion rates can cause deterioration of cerebrovascular pressure auto regulation in patients with head injury.
Administration of propofol to produce sedation in patients with intracranial space-occupying lesions does not increase ICP.