Although ketamine elevates cerebrospinal fluid pressure (CSFP) with an increase in cerebral blood flow, sedatives such as benzodiazepines, barbiturates and opioids have been reported to inhibit it. In this study, we evaluated the changes in epidural pressure (EP) as a good index for CSFP during total intravenous anesthesia with propofol-fentanyl-ketamine (PFK) compared to isofluranenitrous oxide anesthesia (GOI). Twelve patients for gastrectomy were allocated to two groups: PFK (n = 6) and GOI group (n = 6). In PFK group, epidural pressure did not increase during the anesthesia, and was significantly lower than in GOI group (30 and 180 min after induction of anesthesia, and 0, 30 and 60 min after stopping anesthetic administration). The present data suggest that PFK may safely be used for patients with intracranial hypertension.