NEUROLOGIC INJURY can be defined as any temporary or permanent injury to the central and peripheral nervous system, including the brain, spinal cord, and peripheral nerves. This is a major perioperative complication of cardiac and aortic surgery, which can manifest as short-term coma or a state of confusion and long-term decline in cognitive function, behavioral changes, or physical dysfunction. Stroke occurs in approximately 2% to 3% of adult cardiac surgery patients. The rate of postoperative cognitive decline is less clear, due to heterogenous testing methods, but is reported in 50% to 70% of patients at 1 week, 30% to 50% at 6 weeks, and 20% to 40% at 1 year.1, 2 This review evaluates the current rationale and evidence for proposed surgical and nonsurgical techniques for the reduction of neurologic injury.