Cardiac surgery is associated with high incidence of neurological complications, despite the significant improvement in surgery and anaesthesia. Ischemic or hypoperfusion injury is manifested by various postoperative neurological impairments, from stroke, encephalopathy and delirium, to impaired cognitive function. Despite the low incidence, stroke is a very serious consequence of the surgical procedure and it causes permanent disability. Almost half of adult patients exposed to general anaesthesia and surgery may experience postoperative delirium in the intensive care unit. Delirium commonly manifests as a change in mental state, decreased consciousness and attention, cognitive impairment, and is associated with adverse outcomes. Postoperative cognitive impairment is also a common complication of cardiac surgery, especially in the elderly and high-risk patients. The diagnosis is made using a standard neuropsychometric test battery before and after the surgery, which is still used only for research purposes. Causes of neurological complications after cardiac anaesthesia include a combination of embolism, hypoperfusion and inflammatory response, underlying vascular disease and possible autoregulation impairment, all of which make the brain highly susceptible to ischemic injury. There are various brain monitoring devices, that non-invasively and continuously assess the brain electrical activity (EEG, evoked potentials), cerebral blood flow (TCD) and oxygenation (NIRS). Monitoring the brain during anaesthesia and correction of these parameters could help reducing the risk of postoperative neurological complications. Brain protection is achieved by intraoperative temperature and acid-base balance, adequate blood flow regulation and oxygenation of the brain. Epiaortic ultrasound prevents embolism and detects atherosclerotic plaques on the ascending aorta. Furthermore, many drugs have been shown useful for protecting the brain in preclinical studies. Anaesthetics affect the brain blood flow, autoregulation and reduce the metabolism. Neuroprotective properties of other drugs in cardiac anaesthesia are being intensively studied.