Objective To observe the effects of propofol or sevoflurane combined with remifentanil on cerebral blood flow (CBF) and cerebral autoregulation in patients undergoing gynecologic laparoscopic surgery. Methods Forty patients were randomly divided into two groups: the propofol group (group P, n=20) and the sevoflurane group (group S, n=20). Anaesthesia was induced with target-controlled infusion (TCI) of propofol and remifentanil in group P, with an inhaled induction of sevoflurane and TCI of remifentanil in group S, respectively. The depth of anesthesia was regulated according to bispectral index (BIS). The pressure of end-tidal carbon dioxide (PETCO₂) was kept at 35-40 mmHg by mechanical ventilation. The mean arterial pressure (MAP), heart rate (HR), pressure of arterial carbon dioxide (PaCO₂), PETCO₂, time-averaged peak flow velocity (TAP) and the transient hyperaemic response ratio (THRR) were recorded at 7 different time points: supine position (T₁) and supine lithotomy position before induction (T₂), the instant and 5 min after tracheal intubation (T₃, T₄), the instant and 15 min after abdominal CO₂ insufflation and trendelenburg-lithotomy position (T₅, T₆), and 10 min after the deflation abdomen (T₇), respectively. Results Compared with the baseline values at T₁, TAP was not significantly changed at T₂, T₅, or T₆ in group P, but was markedly decreased at T₃, T₄ and T₇. TAP in group S only decreased at T₄ and T₇, while it was much higher than that in group P at T₃. In group S, THRR was markedly lowered at T₃ compared with that at T₁; but in group P, it showed a significant increase at T₃. Conclusions Combined with remifentanil, propofol decreased CBF, but has no effect on the brain self-regulation. When inhaled in high concentrations, sevoflurane significantly reduces the brain self-regulation. Intraoperation pneumoperitoneum and postural factor significantly increase CBF, playing a stronger role than the narcotic drugs in clinical dosage (propofol, sevoflurane), without any influence on the brain self-regulation.