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Estimation of intravascular volume and tissue perfusion remains a challenge in the operating room and post operative period.The development of noninvasivc cardiac output monitors offer the potential to identify and correct low output states.More controversial is the role of target-directed fluid administration whereby noninvasive cardiac output monitors are used to individualise intravenous fluid therapy and potentially modify patient outcome.We will discuss the current noninvasive cardiac output monitors and the evidence supporting target directed fluid administration.