Abstract: Objective To apply bispectral index in anesthesia during piggyback orthotopic liver transplantation, and evaluate the patients' circulation, liver and renal function, and anesthetic effect to guide anesthetic drug administration at different phase of transplatation. Methods Clinical data of 48 patients underwent piggyback orthotopic liver transplantation in Chinese PLA 309th Hospital from January 2014 to December 2016 were retrospectively analyzed. All patients were treated with static inhalation anesthesia to keep BIS value between 40 and 50. Then the characteristics of circulation, liver and kidney function, anesthetic drugs usage and urine volume were analyzed. Results All the 48 surgeries had been successfully completed with the total operating time of (8.6±1.2) h, among which, the pre-anhepatic phase was (3.6±0.7) h, the anhepatic phase was (1.5±0.2) h, and the hepatic reperfusion phase was (3.8±0.4) h. During the time from the pre-anhepatic phase to the hepatic reperfusion phase, the cardiac output and accumulation of lactic acid, and the liver and kidney function all increased, while the creatinine clearance decreased, and the urine firstly reduced and then increased gradually (P< 0.05, respectively). The total amount of propofol was (169.9±36.5) ml with the pre-anhepatic phase infusion rate of (4.5±0.9) mg/(kg·h), and then reduced to (2.1±0.7) mg/(kg·h) in the anhepatic phase. The dosage of propofol in hepatic reperfusion phase began to increase with the rate of (2.6±0.6) mg/kg·h (P< 0.05). Conclusion The circulation, liver and kidney function of patients underwent piggyback liver transplantation will change at different transplantation phases. BIS monitoring system can be a better method to guide the drug usage and increase the safety of anesthesia during operation.