Lopez MG, et al. - Whether intraoperative oxidative damage is related to delirium and neuronal injury and whether these links are modified by disruption of the blood–brain barrier, was investigated in this prespecified cohort analysis including 400 cardiac surgery patients registered in a clinical trial of atorvastatin to decrease kidney injury and delirium. Researchers recorded plasma levels of F₂-isoprostanes and isofurans employing gas chromatography-mass spectrometry to quantify oxidative damage, ubiquitin carboxyl-terminal hydrolase isozyme L1 for the quantification of neuronal injury, and S100 calcium-binding protein B utilizing enzyme-linked immunosorbent assays to quantify blood–brain barrier disruption prior to, during, and following surgery. For a median of 1.0 days, the occurrence of delirium was reported in 109 of 400 (27.3%) patients. Findings revealed an association of intraoperative oxidative damage with increased postoperative delirium and neuronal injury. Patients with increased blood–brain barrier disruption showed a stronger link between oxidative damage and neuronal injury.