Background: Neurosurgery is a medical specialty which is concerned with the prevention,rndiagnosis, treatment and rehabilitation of disorders that affect the entire nervous system.rnHemodynamic change is one of the complications of neurosurgery with an incidence differing withrnmultiple factors. Positioning during neurosurgery has an impact on airway pressure. Poor anestheticrnmanagement during neurosurgery will lead to permanent injuries to the patient, which otherwise arernlargely preventable.rnObjective: The aim of this study is to assess magnitude of hemodynamic and airway pressurernchange and factors associated with intraoperative hypotension during elective neurosurgery inrnTikur Anbessa specialized hospital and Empress Zewditu memorial hospital, 2017rnMethod: Institutional based cross sectional study was used from December 20, 2016 to May 20,rn2017 using pre-tested, interviewer administered questionnaire for 208 patients. Due to rarity ofrnthe procedure all eligible patients who underwent elective neurosurgery at Tikur AnbessarnSpecialized hospital and Empress Zewditu memorial hospital during the data collection periodrnwere included in the study. The data was entered to Epi Info version 7.2.1 and analyzed by SPSSrnversion 20 software performing descriptive statistics, bivariate and multivariate logisticrnregression.rnResult: The magnitude of intraoperative hypotension is found to 29.3% (95% CI: 22%-35%).rnIntraoperative Hypertension had magnitude of 1% (95%CI: 0.0%-2.4%) with bradycardia andrntachycardia having 2.4% (95%CI: 0.5%-4.8%) and 1% (95%CI: 0.0%-2.9%) respectively. Bloodrnloss of >10ml/Kg has >5 times [AOR=5.77; 95% CI: (1.97, 16.83)] more risk for developingrnintraoperative hypotension and Phenytoin use [AOR=6.96; 95% CI: (1.97, 24.50)] hadrnsignificant association with intraoperative hypotension.rnConclusion and recommendation: The magnitude of intraoperative hypotension is high. Somernof the identified factors were Blood loss of >10ml/Kg and Phenytoin use. Therefore earlyrnanticipation and preparation of intraoperative hypotension in patients especially taking phenytoinrnand risk of increased blood loss can improve patient outcome.