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This is not a difficult procedure, and medical students are often allowed to insert a chest tube (under supervision) after having seen just once how to properly do it

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10.1264/jsme2.23.73 53 ShanH.ChenD.LiJ.ChenT.HuH.GuoZ.et al (2011)

Hence, you will need more anesthesia than a non-smoker, which is risky if not done right