Hemodynamic disturbance during watertight dural closure? Mind the direction of saline irrigation!!!

they turned out to be lung overinflation and subcutaneous emphysema on computed tomography. In severe cases of lung overinflation, there is a minimal expansion of lung on inspiration leading to minimal lung sliding seen on US. It can be mistaken as a lack of lung sliding. Moreover, in subcutaneous emphysema, pockets of air in subcutaneous tissues make identification of pleural line difficult, leading to poor recognition of lung sliding. We suggest the use of power Doppler to identify lung sliding (power slide sign). Power Doppler is very sensitive and picks up subtle flow and movement. If there is lung sliding present, power Doppler will light up the sliding pleural line with color flow. This technique is helpful in cases of subtle sliding when direct visualization is difficult. However, any movement of patient’s body or probe during the examination may produce an artifact leading to an error in the judgment.[4]