Do these forums in any way use the registry to handle topic subscriptions? If so, it might be useful to dig into the code for Discuss to see what's going on there...No, they don't.
It certainly can, since in a typical load-balanced environment the database servers are not local to the web servers, forcing a much more expensive database connection via TCP (rather than via local sockets). You can use your own session handler however very easily. I've seen some very high-traffic deployments successfully use the default file-based PHP session handler (just set the session_handler_class System Setting to blank to use whatever session handler you have configured for in your PHP ini) along with something called "sticky" sessions, where a specific client remains on a specific web node for the duration of their session (controlled by the load balancer).
1. The sessions in the db, does this place much of an extra burden on the mysql instances running on each server?
I mean would it be a concern for very highly trafficked sites?
That is a good summary of what I detailed, yes. When clearing cache from the manager, the first plugin looks up all the web node instances currently registered by the remote commands plugin and sends a command message to each instance to clear it's local cache.
2. Cache: We use a separate sub-domain to manipulate a master DB, which is sync'ed with each web server. The file systems on each server are identical, so i guess each server can maintain a separate cache. How could we set up the cms master domain to force each box to clear it cache when the master db is updated? Is this what u detailed with the two plugins?
Not at the moment, but great idea for a future presentation.
I've used MODx for years, but now need to try and sell it into a much bigger setup than i am used to (single sites running 1 instance of modx), have you any killer PowerPoint slides knocking about regarding MODx and large multiserver setups?

Not at the moment, but great idea for a future presentation.
I will have to look into CI's caching mechanisms to give you an answer on this another time; I am not familiar.
Cache: At the moment we use CI fragment caching and DB caching.
1. How does the new Revo caching stand up to these?
There are many partitions involved in MODX caching, responsible for specific pieces of data, and yes, each Context has it's own part of the context_settings partition.
2. Is caching done per Context, as I want to setup multiple domains in the one install, and then setup users who can access Contexts (IE restrict one user to one domains.....another guy can see 2 domains etc etc)
You could extend the RemoteCommands plugin to refresh specific Contexts, specific Partitions, or just about anything you can imagine. See http://rtfm.modx.com/display/revolution20/Caching#Caching-UsingmodCacheManager%3A%3Arefresh%28%29%28forMODX2.1andlater%29 for more information on refreshing the MODX cache.
3. Can I clear the cache for one site...or would the plugin just send a general flush for all contexts?
It would be much less complex to have one domain, separate from any of the front-end Contexts, serve the manager UI and serve as the main instance. If you need site-specific managers to respond on each domain, then you might be better off using separate installs.
4. From your experience, would we be better maintaining seperate managers per site, to avoid the more complex setup (doing this is not an issue)