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The institution of CPB has profound effects on the plasma concentration, distribution and elimination of drugs. The major factors responsible for this are haemodilution, altered plasma protein binding, altered regional blood flow, hypothermia, isolation of the lungs from the circulation and sequestration of drugs into components of the extracorporeal circuit. These changes, which are influenced by physicochemical and pharmacokinetic characteristics, result in an alteration in free drug and effector-site concentration.