Typically, the greatest interest and concern of the course attendees was to practice use of the rigid bronchoscope, as the majority of course attendees did not have prior training or experience with it. Faculty members most often emphasize that a large proportion of laser bronchoscopy should be done through rigid bronchoscopes and with a general anesthetic in humans, although there are reports that local anesthesia and flexible bronchoscopes are acceptable alternatives and may even be preferable for the majority of patients with obstructing bronchogenic carcinomas. Even those practitioners of laser bronchoscopy who take the latter stance state that physicians performing laser bronchoscopy need to have the skills to use the rigid bronchoscope as well. ventolin inhalers
If this recommendation has merit, and I think it does, this creates a very real dilemma for most physicians who attend laser bronchoscopy courses. The majority of thoracic surgeons and otorhinolaryn-gologists in practice come with some skills in the use of rigid bronchoscopes. This is not typically true for practicing pulmonary physicians, who have been taught only how to use flexible bronchoscopes in their fellowship training programs. It is simply not possible during the course of a two-day laser bronchoscopy course to learn how to use a rigid bronchoscope well and use it safely in humans. Moreover, it is far easier to insert a rigid bronchoscope into an anesthetized canine model than it is to bronchoscope a human subject, even with general anesthesia and muscle paralysis. Another problem is that the canine tumor models used in laser bronchoscopy courses do not bleed as much as real tumors during laser bronchoscopy in humans, so the course attendee may get a false sense of security that ablating tumors is less fraught with problems than is true in humans. Moreover, with the tumor model just described, it is nearly impossible to simulate one technique of ablating tumors by using the laser at low power settings to “photocoagulate” the tumor, followed by “coring out” the bulk of the tumor with the rigid bronchoscope and/or removing large chunks of the tumor, as is often the way such tumors are debulked in humans (the laser, therefore, is often simply an adjunct to facilitate tumor removal when this technique is chosen).