Background Anesthesia is not only keeping the surgical patients sedative , analgesia, muscle relaxation, less stress reaction, but also paying more attention to protect the organ during the operation in modern time. The anesthetists need to monitor more parameters of cardiovascular system, especially when they treatment the patients with severe organ dysfunction, in order to optimize the preload, contractility and afterload of the heart whilst maintaining an adequate coronary perfusion pressure. Objective The article reviews the applications of goal-directed therapy in high risk surgical patients. Content The goal directed therapy includes the use of fluid loading and inotropes, in order to optimize the preload, contractility and afterload of the heart whilst maintaining an adequate coronary perfusion pressure. The background, evidence, and how to perform goal directed therapy in high risk surgical patients are discussed as follows. Trend goal-directed therapy can provide a more effective and more accurate assessment mothod with high-risk patient for clinical doctors with a brighter prospect .