One hundred consecutive patients were randomly given hypocarbic (Paco2 < 25 torr) or hypercarbic (Paco2 > 60 torr) general anesthesia during carotid endarterectomy to test the effect of the two regimens upon the incidence of postoperative neurological deficit. An indwelling shunt was not used. One patient died, two have permanent neurological deficits and two have temporary neurological deficits. Although hypocarbic patients had fewer neurological complications than hypercarbic patients, the difference was not statistically significant (p < 0.13). Hypercarbia significantly increased the incidence of intraoperative arrhythmia. Also, no relationship was found between the incidence of postoperative stroke and the internal carotid back pressure or the time of carotid occlusion.