Hypoxia impairs neuromuscular transmission in the rat diaphragm. In previous studies, we have shown that nitric oxide (NO) plays a role in force modulation of the diaphragm under hypoxic conditions. The role of NO, a neurotransmitter, on neurotransmission in skeletal muscle under hypoxic conditions is unknown. The effects of the NO synthase (NOS) inhibitor nomega-nitro-L-arginine (L-NNA, 1 mM) and the NO donor spermine NONOate (Sp-NO, 1 mM) were evaluated on neurotransmission failure during nonfatiguing and fatiguing contractions of the rat diaphragm under hypoxic (PO 2 ϳ 5.8 kPa) and hyperoxic conditions (PO 2 ϳ 64.0 kPa). Hypoxia impaired force generated by both muscle stimulation at 40 HZ (P 40 M) and by nerve stimulation at 40 HZ (P 40 N). The effect of hypoxia in the latter was more pronounced. L-NNA increased P 40 N whereas Sp-NO decreased P 40 N during hypoxia. In contrast, neither L-NNA nor Sp-NO affected P 40 N during hyperoxia. L-NNA only slightly reduced neurotransmission failure during fatiguing contractions under hyperoxic conditions. Consequently, neurotransmission failure assessed by comparing force loss during repetitive nerve simulation and superimposed direct muscle stimulation was more pronounced in hypoxia, which was alleviated by L-NNA and aggravated by Sp-NO. These data provide insight in the underlying mechanisms of hypoxia-induced neurotransmission failure. This is important as respiratory muscle failure may result from hypoxia in vivo. Respiratory muscle fatigue, especially that of the diaphragm, is a possible contributor to the development of respiratory failure-for instance, in patients with chronic obstructive pulmonary disease (COPD). 24 Diaphragm fatigue may be the result of a failure of the muscle tissue itself to generate force (contractile fatigue) or failure in neuromuscular transmission. 3 In vitro studies indicate that the contribution of neurotransmission failure to muscle fatigue ranges from 18% 17 to as much as 75%. 1 The importance of neuromuscular transmission failure in the development of respiratory failure has also been demonstrated in intact animals. 5 Hypoxia, a common feature in several respiratory diseases including COPD, adult respiratory distress syndrome, and pneumonia, impairs neuromuscular transmission in the rat diaphragm. 4 However, little is known about the underlying mechanisms of hypoxiainduced neurotransmission failure in the respiratory muscles. In skeletal muscle, nitric oxide (NO) plays a role in the regulation of neural transmission. 31,47 Skeletal muscle is a major source for NO in the body 32 and neuronal NO synthase (nNOS) is present in high concentrations at the postsynaptic surface of the neuromuscular junction of both fast-and slowtwitch fibers. 7,21 Furthermore, NO appears to influence acetylcholine release from presynaptic terminals in several types of neuromuscular junction models, including skeletal muscle. 31,37 We have previously shown that hypoxia-induced impairment in rat diaphragm contractile performance is associated with el...