Objective To determine the effect of hepatic portal occlusion with Pringle maneuver on intraoperative peripheral perfusion index (PI) and accuracy of non-invasive hemoglobin (SpHb) in the elderly patients. Methods Forty-three patients (over 60 years old) undergoing elective liver surgery under general anesthesia in our hospital from June 2013 to January 2014 were enrolled in this study. Time-matched PI, non-invasive hemoglobin (SpHb) and invasive hemoglobin (Hb) before and after Pringle maneuver were recorded. Bland-Altman analysis and linear regression model were used to evaluate the change of PI and difference between SpHb and Hb before and after Pringle maneuver. Results Before hepatic portal occlusion, there were 44 pairs valid test data collected. The percentage of data pairs with PI>1.4 covered 77.3%, that with difference between SpHb and Hb below 1 g/dl took 75.0%, bias of SpHb was 0.62 g/dl, 95% confidence interval was -1.15 to 2.38 g/dl. After hepatic portal occlusion, there were 73 pairs valid test data collected, the percentage of data pairs with PI>1.4 was 67.1%, that with difference between SpHb and Hb below 1 g/dl was 35.6%, bias of SpHb was 1.12 g/dl, 95% confidence interval was -0.98 to 3.23 g/dl. The linear regression showed that the absolute value of difference between SpHb and Hb was negatively correlated with PI (r=-0.32, P<0.05). Conclusion Hepatic portal occlusion with Pringle maneuver decreases accuracy of SpHb in elderly patients by reducing peripheral PI. Invasive testing for Hb should be more reliable to guide blood transfusion decisions after hepatic portal occlusion.