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In addition, the thiolester may directly combat the ability of fentanyl to suppress the central processes driving expiration under fentanyl-induced hypoxic/hypercapnic conditions and/or the direct inhibitory effects of fentanyl on expiratory muscle activity 11,12,13,14,15 , although it should be noted that there is evidence that opioids can actually increase expiratory muscle activity under certain circumstances 135