Many anaesthetics are extensively bound to plasma proteins. This revie
w article deals with the basic principles and the perioperative variab
ility of protein binding. Furthermore the effects of perioperative alt
erations of protein binding on the pharmacokinetics and pharmacodynami
cs are elucidated. Many studies confirm the influence of protein bindi
ng on the uptake, (re)distribution, biotransformation and elimination
of anaesthetics whereas the influence on drug effect is difficult to a
ssess.