Hypocapnia is a common alteration during anesthesia in neonates.To investigate the effects of hypocapnia and hypocapnia combined with hypotension (HCT) on cerebral perfusion and tissue oxygenation in anesthetized piglets.Thirty anesthetized piglets were randomly allocated to groups: moderate hypocapnia (mHC), severe hypocapnia (sHC) and HCT. Cerebral monitoring comprised a tissue oxygen partial pressure and a laser Doppler probe inserted into the brain tissue as well as a near-infrared spectroscopy (NIRS) sensor placed on the skin, measuring regional oxygen saturation. Hypocapnia was induced by hyperventilation (target PaCO mHC: 3.7 - 4; sHC: 3.1 - 3.3 kPa) and hypotension by blood withdrawal and nitroprusside infusion (mean blood pressure: 35 - 38 mmHg). Data were analyzed at baseline, during (Tr20, Tr40, Tr60) and after (Post20, Post40, Post60) treatment.Compared to baseline, tissue oxygen partial pressure decreased significantly and equally during all treatments [mean(SD) at baseline: mHC 35.7(32.45); sHC: 28.1(20.24); HCT 25.4(10.3) and at Tr60: mHC: 29.9(27.36); sHC: 22.2(18.37); HCT: 18.4(9.5) mmHg]. Decreased laser Doppler flow was detected with all treatments at Tr20 [mHC: 0.9(0.18); sHC: 0.88(0.15); HCT: 0.97(0.13) proportion from baseline]. Independently of group, regional oxygen saturation varied only after reverting and not during treatment. Blood lactate, pH, HCO and PaO increased during treatment with no differences between groups.This animal model revealed reduced cerebral blood flow and brain tissue oxygenation during hypocapnia without detectable changes in regional oxygen saturation as measured by NIRS. Changes occurred as early as during moderate hypocapnia. This article is protected by copyright. All rights reserved.